Provider Demographics
NPI:1275225062
Name:STUSSY, SUMMER
Entity Type:Individual
Prefix:MISS
First Name:SUMMER
Middle Name:
Last Name:STUSSY
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 1:2370 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8452
Mailing Address - Country:US
Mailing Address - Phone:903-908-2353
Mailing Address - Fax:
Practice Address - Street 1:130 BROCKINGTON RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3635
Practice Address - Country:US
Practice Address - Phone:501-819-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist