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General NPI Number Information
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NPI Number | 1639067317
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Entity Type | Individual
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Provider Name | SOFIA WILLS MA
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1833 BOULEVARD FL 3
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4382
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Country | US
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Telephone | 954-593-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 SW 20TH AVE APT 101
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City | GAINESVILLE
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State | FL
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Zip | 32607-4391
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Country | US
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Telephone | 954-593-7476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ12609
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License Number State | FL
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