MEDICARE: SUMMER BLAIR DUDLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1790530210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER BLAIR DUDLEY

Provider Business Mailing Address
First Line	:	9407 OWL TRACE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23838-8919
Country	:	US
Telephone Number	:	804-937-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 S LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-2712
Country	:	US
Telephone Number	:	804-764-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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Directions to “ SUMMER BLAIR DUDLEY ” Practice Location

Language	Start Address	Practice Location

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