Provider Demographics
NPI:1013243591
Name:BERGDALE, SOMMER (MA)
Entity Type:Individual
Prefix:MS
First Name:SOMMER
Middle Name:
Last Name:BERGDALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 REDRUTH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1282
Mailing Address - Country:US
Mailing Address - Phone:702-376-0024
Mailing Address - Fax:
Practice Address - Street 1:578 REDRUTH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-1282
Practice Address - Country:US
Practice Address - Phone:702-376-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor