Provider Demographics
NPI:1295992741
Name:SOMMERS, PATRICIA A (MACCCSLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:REDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:14535 W CEDAR TRAIL
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5215
Mailing Address - Country:US
Mailing Address - Phone:262-821-9319
Mailing Address - Fax:
Practice Address - Street 1:N26 W73977 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-523-0933
Practice Address - Fax:262-523-1674
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI337154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42644500Medicaid