Provider Demographics
NPI:1669686275
Name:CHERNOCK SOMLYO, REBECCA C (TCM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:CHERNOCK SOMLYO
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:BECKI
Other - Middle Name:C
Other - Last Name:SOMLYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TCM
Mailing Address - Street 1:11360 STRANG LINE RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4041
Mailing Address - Country:US
Mailing Address - Phone:913-980-2080
Mailing Address - Fax:913-825-1243
Practice Address - Street 1:11360 STRANG LINE RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4041
Practice Address - Country:US
Practice Address - Phone:913-980-2080
Practice Address - Fax:913-825-1243
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100373630AMedicaid