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General NPI Number Information
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NPI Number | 1407936396
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Entity Type | Individual
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Provider Name | MELISSA J SUMMERFIELD MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10134 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-5700
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Country | US
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Telephone | 262-241-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 5517 W WATERFORD LN STE G
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City | APPLETON
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State | WI
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Zip | 54913-8512
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Country | US
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Telephone | 920-358-0165
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 761-125
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License Number State | WI
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