Provider Demographics
NPI:1861266801
Name:TERRY, SONYA ANNE (CPRM-DP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ANNE
Last Name:TERRY
Suffix:
Gender:F
Credentials:CPRM-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18258 ILENE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1924
Mailing Address - Country:US
Mailing Address - Phone:734-883-6176
Mailing Address - Fax:
Practice Address - Street 1:700 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2526
Practice Address - Country:US
Practice Address - Phone:313-702-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist