Provider Demographics
NPI:1518696467
Name:SOMMERVILLE, RAE (SLP)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:SOMMERVILLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SCHWARZ RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2662
Mailing Address - Country:US
Mailing Address - Phone:720-498-8431
Mailing Address - Fax:
Practice Address - Street 1:616 VERMONT ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2221
Practice Address - Country:US
Practice Address - Phone:785-550-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist