Healthcare Provider Details

I. General information

NPI: 1649788720
Provider Name (Legal Business Name): SUMMER HINES M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 LAKE ST NE
WISE VA
24293-7919
US

IV. Provider business mailing address

121 MARTIN ST
JONESVILLE VA
24263-6540
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-8017
  • Fax:
Mailing address:
  • Phone: 276-346-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202003630
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: