Provider Demographics
NPI:1588604763
Name:SOMMERFIELD, REBECCA SIMON (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SIMON
Last Name:SOMMERFIELD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,LPC
Mailing Address - Street 1:3159 N HUMBOLDT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2227
Mailing Address - Country:US
Mailing Address - Phone:414-374-0641
Mailing Address - Fax:
Practice Address - Street 1:1545 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-671-5926
Practice Address - Fax:414-645-7850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3586-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health