Provider Demographics
NPI:1225330731
Name:SUMNER, THERESA J (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:SUMNER
Suffix:
Gender:F
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 1:123 BROLA RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6183
Mailing Address - Country:US
Mailing Address - Phone:845-386-2032
Mailing Address - Fax:845-386-4786
Practice Address - Street 1:123 BROLA RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6183
Practice Address - Country:US
Practice Address - Phone:845-386-2032
Practice Address - Fax:845-386-4786
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3008-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist