Provider Demographics
NPI:1033901806
Name:FLEETWOOD, SOPHIA ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANNE
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S BOULDIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4004
Mailing Address - Country:US
Mailing Address - Phone:667-231-0312
Mailing Address - Fax:
Practice Address - Street 1:119 MARYLAND ROUTE 3
Practice Address - Street 2:SUITE #201
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:443-808-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD706735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist