Provider Demographics
NPI:1316568991
Name:SUMMERS, AMIE (LGSW)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WHITEWATER DR STE 135
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4104
Mailing Address - Country:US
Mailing Address - Phone:651-888-8474
Mailing Address - Fax:
Practice Address - Street 1:12301 WHITEWATER DR STE 135
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4104
Practice Address - Country:US
Practice Address - Phone:651-888-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker