Provider Demographics
NPI:1215764758
Name:DEANER, SOPHIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:DEANER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:115 S SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4147
Mailing Address - Country:US
Mailing Address - Phone:717-761-4754
Mailing Address - Fax:717-370-6315
Practice Address - Street 1:115 S SAINT JOHNS DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4147
Practice Address - Country:US
Practice Address - Phone:717-761-4754
Practice Address - Fax:717-370-6315
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist