Healthcare Provider Details

I. General information

NPI: 1851153092
Provider Name (Legal Business Name): DR. SONIA VAJARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 758
CHICAGO IL
60601-7711
US

IV. Provider business mailing address

155 N MICHIGAN AVE STE 758
CHICAGO IL
60601-7711
US

V. Phone/Fax

Practice location:
  • Phone: 312-448-7983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071011129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: