Provider Demographics
NPI:1083310924
Name:BUTRICO, SUMMER ROSE (HIS)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ROSE
Last Name:BUTRICO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:ROSE
Other - Last Name:SCOZZARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:445 WESTERN BLVD STE O
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6852
Mailing Address - Country:US
Mailing Address - Phone:910-353-4327
Mailing Address - Fax:
Practice Address - Street 1:445 WESTERN BLVD STE O
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:910-353-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1644237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty