=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477984870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNN A SUMMERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2013
-----------------------------------------------------
Last Update Date | 09/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5733 RIVERBOAT CIR SW
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32968-7524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-492-3975
-----------------------------------------------------
Fax | 772-925-8259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5733 RIVERBOAT CIR SW
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32968-7524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-492-3975
-----------------------------------------------------
Fax | 772-925-8259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LYNN ANN APPLEBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-492-3975
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA8774
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------