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General NPI Number Information
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NPI Number | 1104360395
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Entity Type | Individual
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Provider Name | JANET ANN SOMMER PHD
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 314 S RIVER ST
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City | HAILEY
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State | ID
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Zip | 83333-8851
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Country | US
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Telephone | 208-309-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MOTHER LODE LOOP
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City | HAILEY
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State | ID
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Zip | 83333-8598
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Country | US
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Telephone | 208-309-1810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 202961
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3531
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License Number State | ZZ
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