Provider Demographics
NPI:1275945131
Name:SUMNER, ANITA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 OSBORNE RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9165
Mailing Address - Country:US
Mailing Address - Phone:912-576-9603
Mailing Address - Fax:912-576-9865
Practice Address - Street 1:2015 OSBORNE RD
Practice Address - Street 2:UNIT A
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9165
Practice Address - Country:US
Practice Address - Phone:912-576-9603
Practice Address - Fax:912-576-9865
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist