Provider Demographics
NPI:1245121946
Name:BOSACCO, SOPHIA LAINE (BS, MS, CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:LAINE
Last Name:BOSACCO
Suffix:
Gender:F
Credentials:BS, MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54-126 IMUA PL
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717-9518
Mailing Address - Country:US
Mailing Address - Phone:609-675-4602
Mailing Address - Fax:
Practice Address - Street 1:54-046 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HAUULA
Practice Address - State:HI
Practice Address - Zip Code:96717-9647
Practice Address - Country:US
Practice Address - Phone:808-305-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist