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General NPI Number Information
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NPI Number | 1073497533
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Entity Type | Individual
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Provider Name | CHEYNE SUMMER PAGE
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 8060 HWY 55 # 100
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City | ROCKFORD
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State | MN
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Zip | 55373-9407
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Country | US
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Telephone | 612-477-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 1124 MANITOU ST
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City | BIG LAKE
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State | MN
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Zip | 55309-9594
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306873
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5132
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License Number State | MN
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