Provider Demographics
NPI:1083724108
Name:SOMMER, JEANNE SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:SUE
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 1:627 EDWIN C. MOSES BLVD.
Mailing Address - Street 2:5TH FLOOR, SUITE K
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417
Mailing Address - Country:US
Mailing Address - Phone:937-424-1000
Mailing Address - Fax:937-424-1002
Practice Address - Street 1:627 EDWIN C. MOSES BLVD.
Practice Address - Street 2:5TH FLOOR, SUITE K
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-424-1000
Practice Address - Fax:937-424-1002
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist