Healthcare Provider Details

I. General information

NPI: 1578478087
Provider Name (Legal Business Name): SOPHIA BELLA TANZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 LINCOLN AVE
TWO RIVERS WI
54241-1874
US

IV. Provider business mailing address

595 BAETEN RD
GREEN BAY WI
54304-5763
US

V. Phone/Fax

Practice location:
  • Phone: 920-793-4560
  • Fax:
Mailing address:
  • Phone: 920-492-5960
  • Fax: 920-492-5965

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: