Provider Demographics
NPI:1447456603
Name:TRUEBLOOD, SONYA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:S
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-0093
Mailing Address - Country:US
Mailing Address - Phone:262-222-2882
Mailing Address - Fax:262-373-0362
Practice Address - Street 1:19275 W CAPITOL DR STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2734
Practice Address - Country:US
Practice Address - Phone:262-222-2882
Practice Address - Fax:262-373-0362
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2975-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40994100Medicaid