MEDICARE: MRS. JENNIFER TERRY SUMMERS MACCCSLP

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	22004046A	IN

General Provider Information

NPI Number	:	1669668448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER TERRY SUMMERS MACCCSLP

Provider Business Mailing Address
First Line	:	9505 E 59TH ST
Second Line	:	SUITE B1
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-1025
Country	:	US
Telephone Number	:	317-542-7680
Fax Number	:	317-542-7682

Provider Business Practice Location Address
First Line	:	9505 E 59TH ST
Second Line	:	SUITE B1
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-1025
Country	:	US
Telephone Number	:	317-542-7680
Fax Number	:	317-542-7682

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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Directions to “ MRS. JENNIFER TERRY SUMMERS MACCCSLP” Practice Location

Language	Start Address	Practice Location

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