Provider Demographics
NPI:1073761698
Name:SUMMERS, RUSSELL QUENTIN III (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:QUENTIN
Last Name:SUMMERS
Suffix:III
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MOCKINGBIRD LN APT 303
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3611
Mailing Address - Country:US
Mailing Address - Phone:443-912-9698
Mailing Address - Fax:
Practice Address - Street 1:806 MOCKINGBIRD LN APT 303
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3611
Practice Address - Country:US
Practice Address - Phone:443-912-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist