Provider Demographics
NPI:1225889488
Name:ROUSSELLE, SUMMER
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:ROUSSELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WILLAMETTE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3170
Mailing Address - Country:US
Mailing Address - Phone:541-321-2278
Mailing Address - Fax:
Practice Address - Street 1:2440 WILLAMETTE ST STE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3170
Practice Address - Country:US
Practice Address - Phone:541-321-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator