Healthcare Provider Details

I. General information

NPI: 1801726096
Provider Name (Legal Business Name): SOPHIE VERITY TOMMERDAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SE OCEAN BLVD STE 300
STUART FL
34994-2164
US

IV. Provider business mailing address

1323 W PLUM ST APT 308
FORT COLLINS CO
80521-3531
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 214-801-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: