Healthcare Provider Details

I. General information

NPI: 1346316346
Provider Name (Legal Business Name): MEGAN K SUMMERS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CURLEW DR STE. 5
AMMON ID
83406-4719
US

IV. Provider business mailing address

PO BOX 3629
IDAHO FALLS ID
83403-3629
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-1286
  • Fax: 208-535-1291
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-1187
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: