1104033596 NPI number — MRS. SONYA D HAWTHORNE DT

Table of content: MRS. SONYA D HAWTHORNE DT (NPI 1104033596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104033596 NPI number — MRS. SONYA D HAWTHORNE DT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWTHORNE
Provider First Name:
SONYA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104033596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21141 GOVERNORS HWY
Provider Second Line Business Mailing Address:
PMB 1073 SUITE 114
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-3818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-218-1863
Provider Business Mailing Address Fax Number:
708-418-3913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21141 GOVERNORS HWY
Provider Second Line Business Practice Location Address:
PMB 1073 SUITE 114
Provider Business Practice Location Address City Name:
MATTESON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60443-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-218-1863
Provider Business Practice Location Address Fax Number:
708-418-3913
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  SH77250900P , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 364457327 . This is a "DT CERTIFICATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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