MEDICARE: DR. SCOTT MICHAEL SONNEK PH.D.

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	103T00000X	Psychologist	355	WY

General Provider Information

NPI Number	:	1700807112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT MICHAEL SONNEK PH.D.

Provider Business Mailing Address
First Line	:	1103 LOCUST STREET
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405
Country	:	US
Telephone Number	:	406-727-5173
Fax Number	:	406-731-3231

Provider Business Practice Location Address
First Line	:	7300 NORTH PERIMETER ROAD
Second Line	:
City	:	MALMSTROM AFB
State	:	MT
Zip	:	59402-6780
Country	:	US
Telephone Number	:	406-731-4451
Fax Number	:	406-731-3231

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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