Provider Demographics
NPI:1801954938
Name:SOMMERS-KRAUSE, DEBORAH L (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:SOMMERS-KRAUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1348
Mailing Address - Country:US
Mailing Address - Phone:309-945-7059
Mailing Address - Fax:
Practice Address - Street 1:128 S STATE ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1348
Practice Address - Country:US
Practice Address - Phone:309-945-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490071531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149007153OtherSTATE LICENSE NUMBER
IL050629030OtherEMPLOYER IDENTIFICATIN NO
IL050629030OtherEMPLOYER IDENTIFICATIN NO