Provider Demographics
NPI:1457376956
Name:SOMMER, LOUISE ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ANN
Last Name:SOMMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 E PARIS AVE SE
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8371
Mailing Address - Country:US
Mailing Address - Phone:616-454-2004
Mailing Address - Fax:616-454-0061
Practice Address - Street 1:1179 E PARIS AVE SE
Practice Address - Street 2:SUITE # 220
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8371
Practice Address - Country:US
Practice Address - Phone:616-454-2004
Practice Address - Fax:616-454-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010189021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892884Medicare ID - Type UnspecifiedPROVIDER ID #