Provider Demographics
NPI:1124521505
Name:MCNEIL, SONYA JOYCE
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:JOYCE
Last Name:MCNEIL
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 1:104 BRADYL ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2814
Mailing Address - Country:US
Mailing Address - Phone:606-524-6469
Mailing Address - Fax:
Practice Address - Street 1:KIDABILITIES PEDIATRIC THERAPY CENTER
Practice Address - Street 2:2801 HIGHWAY 25E, SUITE 98
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-302-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist