Healthcare Provider Details

I. General information

NPI: 1306498779
Provider Name (Legal Business Name): ANNE B SUMMERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E. KINGSLEY ST., STE C
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

2110 W. MELBOURNE CT.
SPRINGFIELD MO
65810
US

V. Phone/Fax

Practice location:
  • Phone: 417-894-3992
  • Fax: 417-332-8680
Mailing address:
  • Phone: 417-894-3992
  • Fax: 417-332-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANNE BREDEMAN SUMMERS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: PHD, MSW, LCSW
Phone: 417-894-3992