Healthcare Provider Details

I. General information

NPI: 1194059683
Provider Name (Legal Business Name): SONYIA A WARD MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 W CHICAGO RD
COLDWATER MI
49036-8405
US

IV. Provider business mailing address

PO BOX 2588
PORTAGE MI
49081-2588
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-8866
  • Fax:
Mailing address:
  • Phone: 269-373-8878
  • Fax: 269-373-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: