MEDICARE: NICOLE SUMMERS LCSW

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	1041C0700X	Clinical Social Worker	992166	CO

General Provider Information

NPI Number	:	1396704664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SUMMERS LCSW

Provider Business Mailing Address
First Line	:	281 AUGITE PL
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-2006
Country	:	US
Telephone Number	:	970-518-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121E HARMONY RD 250
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3402
Country	:	US
Telephone Number	:	970-518-8516
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/02/2015

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