Provider Demographics
NPI:1497053441
Name:MORRISON, SUMMER BROOKE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:BROOKE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:SUMMER
Other - Middle Name:BROOKE
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437
Mailing Address - Country:US
Mailing Address - Phone:870-897-6464
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHWEST SQ.
Practice Address - Street 2:CREATIVE KIDS THERAPY
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-336-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185931721Medicaid