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General NPI Number Information
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NPI Number | 1235707274
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Entity Type | Individual
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Provider Name | PAYTON SOMERVILLE
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 200 4TH AVE W
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City | SHAKOPEE
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State | MN
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Zip | 55379-1220
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Country | US
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Telephone | 952-496-8481
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Fax |
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Provider Business Mailing Address
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Address Line | 663 CARVER BLUFFS PKWY
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City | CARVER
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State | MN
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Zip | 55315-9516
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Country | US
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Telephone | 195-241-2294
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 68864
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License Number State | MN
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