Provider Demographics
NPI:1518415454
Name:SOMMERLOT, CARA (EDS)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:SOMMERLOT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-1735
Mailing Address - Country:US
Mailing Address - Phone:605-256-5555
Mailing Address - Fax:
Practice Address - Street 1:820 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-1735
Practice Address - Country:US
Practice Address - Phone:605-256-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD69234-1103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool