Healthcare Provider Details

I. General information

NPI: 1851817811
Provider Name (Legal Business Name): STEPHANIE SOMMERFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 DWIGHT RD
ELK GROVE CA
95758-6456
US

IV. Provider business mailing address

17880 GLENWOOD RD
MANTECA CA
95336-9521
US

V. Phone/Fax

Practice location:
  • Phone: 916-427-7141
  • Fax:
Mailing address:
  • Phone: 209-328-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: