MEDICARE: SOPHIA SYVERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SLPA417	OK

General Provider Information

NPI Number	:	1235062043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA SYVERSON

Provider Business Mailing Address
First Line	:	12895 FM 1280
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-9035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12895 FM 1280
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-9035
Country	:	US
Telephone Number	:	913-293-7375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ SOPHIA SYVERSON ” Practice Location

Language	Start Address	Practice Location

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