Provider Demographics
NPI:1861602856
Name:SOMMERFELDT, VICKI (MT-BC, NMT, LNHA)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:SOMMERFELDT
Suffix:
Gender:F
Credentials:MT-BC, NMT, LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WHITE PINE RD
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-5451
Mailing Address - Country:US
Mailing Address - Phone:651-481-9532
Mailing Address - Fax:
Practice Address - Street 1:155 WHITE PINE RD
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-5451
Practice Address - Country:US
Practice Address - Phone:651-481-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist