Healthcare Provider Details

I. General information

NPI: 1124970652
Provider Name (Legal Business Name): SONIA AMLIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MILUK DR
COOS BAY OR
97420-7728
US

IV. Provider business mailing address

630 MILUK DR
COOS BAY OR
97420-7728
US

V. Phone/Fax

Practice location:
  • Phone: 541-888-9494
  • Fax: 541-262-2388
Mailing address:
  • Phone: 541-888-9494
  • Fax: 541-262-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR10437
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: