Provider Demographics
NPI:1154849537
Name:SUMNER, KATHRYN (MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NATURE WALK PKWY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5073
Mailing Address - Country:US
Mailing Address - Phone:904-230-7761
Mailing Address - Fax:
Practice Address - Street 1:111 NATURE WALK PKWY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5073
Practice Address - Country:US
Practice Address - Phone:904-230-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist