Individual
SOPHIA BASLANDZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
606 E BALTIMORE PIKE, MEDIA, PA 19063-1751
(610) 864-7376
Mailing address
5 REVERE DR, NORTHBROOK, IL 60062-1566
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
11833036
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
11/27/2023
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