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NPI Code Detail

MEDICARE: SUMMER HALL

MEDICARE: SUMMER HALL
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1407699713
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMMER HALL
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-204-0116
Fax Number :
Provider Business Practice Location Address
First Line : 1045 12TH AVE
Second Line :
City : EAST MOLINE
State : IL
Zip : 61244-1474
Country : US
Telephone Number : 563-526-0533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2024
Last Update Date : 06/14/2024

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Directions to “ SUMMER HALL ” Practice Location

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