Provider Demographics
NPI:1003120296
Name:SOMMER, JENNIFER LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:SOMMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509B W FRIENDLY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4270
Mailing Address - Country:US
Mailing Address - Phone:336-272-0855
Mailing Address - Fax:336-272-9885
Practice Address - Street 1:5509B W FRIENDLY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4270
Practice Address - Country:US
Practice Address - Phone:336-272-0855
Practice Address - Fax:336-272-9885
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003120296Medicaid