Basic Information
| Provider Information | |||||||||
| NPI: | 1023549680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE SONDER ACADEMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 S JOHN RODES BLVD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329041093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212411170 | ||||||||
| FaxNumber: | 3212411171 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 S JOHN RODES BLVD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212411170 | ||||||||
| FaxNumber: | 3212411171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | TODD | ||||||||
| AuthorizedOfficialFirstName: | MONIQUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3212411170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A. ED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.