MEDICARE: SOPHIA WAKEFIELD

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1801733142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA WAKEFIELD

Provider Business Mailing Address
First Line	:	850 TOWBIN AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5928
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 N MICHIGAN AVE FL 31
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-1962
Country	:	US
Telephone Number	:	833-566-2560
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ SOPHIA WAKEFIELD ” Practice Location

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