1588604763 NPI number — MRS. REBECCA SIMON SOMMERFIELD MA, LPC

Table of content: DR. RACHEL K. CHANEY M. D, (NPI 1871513887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588604763 NPI number — MRS. REBECCA SIMON SOMMERFIELD MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMMERFIELD
Provider First Name:
REBECCA
Provider Middle Name:
SIMON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA,LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588604763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3159 N HUMBOLDT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-2227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-374-0641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 S LAYTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-671-5926
Provider Business Practice Location Address Fax Number:
414-645-7850
Provider Enumeration Date:
06/07/2006

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: 101YM0800X , with the licence number:  3586-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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