Provider Demographics
NPI:1114733821
Name:SLOAN, SOPHIA M
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:M
Last Name:SLOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 SE MARION ST APT 16
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7366
Mailing Address - Country:US
Mailing Address - Phone:971-335-1614
Mailing Address - Fax:
Practice Address - Street 1:2026 SE MARION ST APT 16
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7366
Practice Address - Country:US
Practice Address - Phone:971-335-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula