Provider Demographics
NPI:1104360395
Name:SOMMER, JANET ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ANN
Last Name:SOMMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:420 MOTHER LODE LOOP
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8598
Mailing Address - Country:US
Mailing Address - Phone:208-309-1810
Mailing Address - Fax:
Practice Address - Street 1:314 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8851
Practice Address - Country:US
Practice Address - Phone:208-309-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID202961103T00000X
ZZ3531103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist