Provider Demographics
NPI:1699708024
Name:ZOMERLAND, GUDRUN (MFT)
Entity type:Individual
Prefix:MS
First Name:GUDRUN
Middle Name:
Last Name:ZOMERLAND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHINN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4309
Mailing Address - Country:US
Mailing Address - Phone:707-575-8468
Mailing Address - Fax:707-566-7867
Practice Address - Street 1:405 CHINN ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4309
Practice Address - Country:US
Practice Address - Phone:707-575-8468
Practice Address - Fax:707-566-7867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT276171Medicare UPIN