Healthcare Provider Details

I. General information

NPI: 1912862483
Provider Name (Legal Business Name): SOFIA BOHANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 COCHRAN RD STE 2
SOLON OH
44139-3930
US

IV. Provider business mailing address

345 S DEPEYSTER ST APT 306
KENT OH
44240-3727
US

V. Phone/Fax

Practice location:
  • Phone: 440-498-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: