=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336893296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONYA'S PRIVATE PRACTICE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2022
-----------------------------------------------------
Last Update Date | 06/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16010 SE 250TH CT
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-951-1872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16010 SE 250TH CT
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-951-1872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SONYA HARKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-951-1872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------