Provider Demographics
NPI:1326522178
Name:SUMMERS, JENNIFER ANN MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DEVONSHIRE DRIVE
Mailing Address - Street 2:SUITE B16-18
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7328
Mailing Address - Country:US
Mailing Address - Phone:217-531-2360
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DRIVE
Practice Address - Street 2:SUITE B16-18
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7328
Practice Address - Country:US
Practice Address - Phone:217-531-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor