Provider Demographics
NPI:1285443374
Name:SOMMERS, MICHELLE (LPC-IT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9328
Mailing Address - Country:US
Mailing Address - Phone:414-640-1289
Mailing Address - Fax:
Practice Address - Street 1:11516 N PORT WASHINGTON RD STE 208
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3441
Practice Address - Country:US
Practice Address - Phone:262-518-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8236-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional