Individual
SOPHIA POLARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
Mailing address
2427 E OKLAHOMA AVE, MILWAUKEE, WI 53207-3059
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4584
WI
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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