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General NPI Number Information
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NPI Number | 1447500855
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Entity Type | Individual
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Provider Name | JENAE MICHELLE SUMMEROUR LMT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 4847 MEADOWS RD STE 153
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2626
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Country | US
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Telephone | 971-330-8578
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Fax | 971-330-8579
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Provider Business Mailing Address
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Address Line | 22214 S MARILYNS AVE
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City | BEAVERCREEK
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State | OR
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Zip | 97004-9667
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Country | US
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Telephone | 503-747-9705
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Fax | 503-747-9705
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12844
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC204932
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License Number State | OR
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