Provider Demographics
NPI:1164700308
Name:SOMMERFELD, TANYA LYN (MA, LP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYN
Last Name:SOMMERFELD
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:LYN
Other - Last Name:NESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:201 EAST MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303
Mailing Address - Country:US
Mailing Address - Phone:763-201-8065
Mailing Address - Fax:763-712-5588
Practice Address - Street 1:201 EAST MAIN STREET SUITE 200
Practice Address - Street 2:SOUTH METRO HUMAN SERVICES
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-201-8065
Practice Address - Fax:763-712-5588
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist