MEDICARE: DENISE K. SOMMERS LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1588735039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE K. SOMMERS LCPC

Provider Business Mailing Address
First Line	:	1124 S 5TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2314
Country	:	US
Telephone Number	:	217-744-3525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 S 5TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2314
Country	:	US
Telephone Number	:	217-744-3525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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