Provider Demographics
NPI:1699505495
Name:MAZLOUM, SOPHIE ANNA (SLP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANNA
Last Name:MAZLOUM
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 1:2935 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2838
Mailing Address - Country:US
Mailing Address - Phone:614-314-6725
Mailing Address - Fax:
Practice Address - Street 1:5345 KYLES STATION RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-8400
Practice Address - Country:US
Practice Address - Phone:513-755-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20242811-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist