Healthcare Provider Details

I. General information

NPI: 1295201788
Provider Name (Legal Business Name): WHITNEY MORGAN SOMMERVILLE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE STE 410
CHICAGO IL
60611-5800
US

IV. Provider business mailing address

529 W WELLINGTON AVE APT 45
CHICAGO IL
60657-5463
US

V. Phone/Fax

Practice location:
  • Phone: 312-274-0197
  • Fax:
Mailing address:
  • Phone: 937-838-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001690
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: