Healthcare Provider Details

I. General information

NPI: 1699070219
Provider Name (Legal Business Name): MELISSA SOMMERS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 N MARMORA AVE
CHICAGO IL
60630-1910
US

IV. Provider business mailing address

PO BOX 56015
HARWOOD HEIGHTS IL
60656-0922
US

V. Phone/Fax

Practice location:
  • Phone: 818-394-0649
  • Fax:
Mailing address:
  • Phone: 818-394-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: