Provider Demographics
NPI:1104623933
Name:VERVOORN, SONYA
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:VERVOORN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:VERVOORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1389 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2101
Mailing Address - Country:US
Mailing Address - Phone:317-564-0934
Mailing Address - Fax:
Practice Address - Street 1:1389 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2101
Practice Address - Country:US
Practice Address - Phone:317-564-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician