Healthcare Provider Details

I. General information

NPI: 1356760557
Provider Name (Legal Business Name): SONYA K VANBEMMEL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 N MERIDIAN RD
KALISPELL MT
59901-3095
US

IV. Provider business mailing address

1312 N MERIDIAN RD
KALISPELL MT
59901-3095
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-6453
  • Fax: 406-756-8546
Mailing address:
  • Phone: 406-756-6453
  • Fax: 406-756-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15683-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-42619
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: