Provider Demographics
NPI:1285324129
Name:DOHERTY, SOPHIE ANNE (SLP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANNE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STUB TOE LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1054
Mailing Address - Country:US
Mailing Address - Phone:774-278-0613
Mailing Address - Fax:
Practice Address - Street 1:140 GOULD ST STE 290
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2397
Practice Address - Country:US
Practice Address - Phone:781-400-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist