Healthcare Provider Details

I. General information

NPI: 1922967488
Provider Name (Legal Business Name): SOPHIA PEARSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 WESTBROOK DR
AURORA IL
60504-4124
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-1818
  • Fax: 630-527-1244
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-012047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: