Provider Demographics
NPI:1316767288
Name:RAGAN, SOPHIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:RAGAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-2664
Mailing Address - Country:US
Mailing Address - Phone:609-816-2315
Mailing Address - Fax:
Practice Address - Street 1:159 LAKE DR
Practice Address - Street 2:
Practice Address - City:BROOKLAWN
Practice Address - State:NJ
Practice Address - Zip Code:08030-2664
Practice Address - Country:US
Practice Address - Phone:609-816-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist