Healthcare Provider Details

I. General information

NPI: 1487019162
Provider Name (Legal Business Name): REBECCA MARIE SOMODI DT-ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W 806 N
VALPARAISO IN
46385-7973
US

IV. Provider business mailing address

PO BOX 2385
PORTAGE IN
46368-5885
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-4888
  • Fax: 219-764-7676
Mailing address:
  • Phone: 219-764-4888
  • Fax: 219-764-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: