Provider Demographics
NPI:1932951274
Name:SOMMER, BETSY (LISW)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1106
Mailing Address - Country:US
Mailing Address - Phone:952-465-7160
Mailing Address - Fax:
Practice Address - Street 1:2805 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2074
Practice Address - Country:US
Practice Address - Phone:563-265-1529
Practice Address - Fax:563-726-7500
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1086991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty