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General NPI Number Information
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NPI Number | 1962592345
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Entity Type | Individual
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Provider Name | CHANNELL SUMMERS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 1024 CORALBEAN WAY
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-234-8944
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Fax |
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Provider Business Mailing Address
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Address Line | 803 DAHLIA CT
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City | JACKSONVILLE
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State | NC
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Zip | 28546-4627
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Country | US
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Telephone | 803-378-3768
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Fax | 910-939-1530
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3833
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8967
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License Number State | NC
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