Provider Demographics
NPI:1376774604
Name:FROMMER, ILENE SCHLAEPPI (MFT)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:SCHLAEPPI
Last Name:FROMMER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:ILENE
Other - Middle Name:RAE
Other - Last Name:FROMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:280 ALMOND WAY
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4354
Mailing Address - Country:US
Mailing Address - Phone:707-433-3054
Mailing Address - Fax:
Practice Address - Street 1:280 ALMOND WAY
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4354
Practice Address - Country:US
Practice Address - Phone:707-433-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFV 16288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist