Healthcare Provider Details

I. General information

NPI: 1205348406
Provider Name (Legal Business Name): LEAH SOPHRIN MS, SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 RICHARDSON ST
NORTHFIELD VT
05663-5644
US

IV. Provider business mailing address

192 BARRE ST
MONTPELIER VT
05602-3625
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-3161
  • Fax:
Mailing address:
  • Phone: 802-498-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number144.0114996
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: