Healthcare Provider Details

I. General information

NPI: 1457376956
Provider Name (Legal Business Name): LOUISE ANN SOMMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 E PARIS AVE SE SUITE # 220
GRAND RAPIDS MI
49546-8371
US

IV. Provider business mailing address

1179 E PARIS AVE SE SUITE # 220
GRAND RAPIDS MI
49546-8371
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-2004
  • Fax: 616-454-0061
Mailing address:
  • Phone: 616-454-2004
  • Fax: 616-454-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801018902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: