MEDICARE: KATHRYN SUMNER MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SZ8244	FL

General Provider Information

NPI Number	:	1154849537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN SUMNER MS

Provider Business Mailing Address
First Line	:	111 NATURE WALK PKWY
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-230-7761
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 NATURE WALK PKWY
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-230-7761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	07/21/2022

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Directions to “ KATHRYN SUMNER MS” Practice Location

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