Healthcare Provider Details

I. General information

NPI: 1043843311
Provider Name (Legal Business Name): SOPHIE JEROMA MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 5TH AVE NE STE 101
SEATTLE WA
98115-4186
US

IV. Provider business mailing address

8401 5TH AVE NE STE 101
SEATTLE WA
98115-4186
US

V. Phone/Fax

Practice location:
  • Phone: 206-880-0593
  • Fax:
Mailing address:
  • Phone: 206-880-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: