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General NPI Number Information
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NPI Number | 1790806446
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Entity Type | Individual
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Provider Name | SOFIA MARGARITA SOUTO M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 200 S JORDAN AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47405-7002
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Country | US
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Telephone | 812-855-7348
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 E 10TH ST APT. A4
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City | BLOOMINGTON
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State | IN
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Zip | 47408-2492
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Country | US
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Telephone | 305-733-6027
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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 | 22005217A
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License Number State | IN
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