Provider Demographics
NPI:1295407393
Name:SOMMERS, EMILIE CAMILLE RYANN (TLMHC)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:CAMILLE RYANN
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BOYSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1270
Mailing Address - Country:US
Mailing Address - Phone:319-250-1267
Mailing Address - Fax:
Practice Address - Street 1:1811 BOYSON RD STE A
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1270
Practice Address - Country:US
Practice Address - Phone:319-250-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health