Provider Demographics
NPI:1588940787
Name:SOMMER, ANGELA RENEE (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:SOMMER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ARMSTRONG STREET
Mailing Address - Street 2:GENESIS REHABILITATION SERVICES CORSICA HILLS
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617
Mailing Address - Country:US
Mailing Address - Phone:410-758-2323
Mailing Address - Fax:410-758-4493
Practice Address - Street 1:205 ARMSTRONG STREET
Practice Address - Street 2:GENESIS REHABILITATION SERVICES CORSICA HILLS
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617
Practice Address - Country:US
Practice Address - Phone:410-758-2323
Practice Address - Fax:410-758-4493
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist