Healthcare Provider Details

I. General information

NPI: 1285532812
Provider Name (Legal Business Name): SOPHIA FRY SWT-QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2026
Last Update Date: 10/26/2026
Certification Date: 10/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S CLINTON ST
THE PLAINS OH
45780-1269
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-249-4330
  • Fax:
Mailing address:
  • Phone: 740-773-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2605469-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: