Provider Demographics
NPI:1780372847
Name:SOMMERVOLD, STACY JO (PSYD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:SOMMERVOLD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7412 E SHADOW PINE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6332
Mailing Address - Country:US
Mailing Address - Phone:304-906-6874
Mailing Address - Fax:
Practice Address - Street 1:7412 E SHADOW PINE CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6332
Practice Address - Country:US
Practice Address - Phone:304-906-6874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical