Provider Demographics
NPI:1467939959
Name:FEASTER, SUMMER DAWN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:DAWN
Last Name:FEASTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:SUMMER
Other - Middle Name:DAWN
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:20021 96TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8281
Mailing Address - Country:US
Mailing Address - Phone:206-550-4860
Mailing Address - Fax:
Practice Address - Street 1:9040 REID STREET
Practice Address - Street 2:ATTN: MCHJ-CLQ-Q
Practice Address - City:TACOMA
Practice Address - State:AA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608073131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical