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General NPI Number Information
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NPI Number | 1912883083
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Entity Type | Individual
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Provider Name | SOPHIE RAE LONGLEY
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Gender | Female
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 555 S OLD 3C RD
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City | SUNBURY
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State | OH
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Zip | 43074-9507
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Country | US
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Telephone | 740-965-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 2891 BOLD VENTURE DR
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City | LEWIS CENTER
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State | OH
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Zip | 43035-7131
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Country | US
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Telephone | 740-972-1129
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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 | COND.20253269-SP
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License Number State | OH
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