Healthcare Provider Details

I. General information

NPI: 1659567394
Provider Name (Legal Business Name): CYNTHIA ELIZABETH HOMMER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 LLOYD LN
FULDA MN
56131-9464
US

IV. Provider business mailing address

706 LLOYD LN
FULDA MN
56131-9464
US

V. Phone/Fax

Practice location:
  • Phone: 507-425-2087
  • Fax:
Mailing address:
  • Phone: 507-425-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11857
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2279
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: