Provider Demographics
NPI:1235813767
Name:SUMMERS, KAITLYN AN-MARIE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:AN-MARIE
Last Name:SUMMERS
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 1:906 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-5335
Mailing Address - Country:US
Mailing Address - Phone:432-212-9449
Mailing Address - Fax:
Practice Address - Street 1:13812 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2403
Practice Address - Country:US
Practice Address - Phone:432-212-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist