Provider Demographics
NPI:1104033596
Name:HAWTHORNE, SONYA D (DT)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:D
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7383 EMERSON CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1781
Mailing Address - Country:US
Mailing Address - Phone:708-218-1863
Mailing Address - Fax:708-418-3913
Practice Address - Street 1:7383 EMERSON CT
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1781
Practice Address - Country:US
Practice Address - Phone:708-218-1863
Practice Address - Fax:708-418-3913
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSH77250900P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364457327OtherDT CERTIFICATION