Provider Demographics
NPI:1518294214
Name:SCOTT, SUMMER ASHLI
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ASHLI
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6839
Mailing Address - Country:US
Mailing Address - Phone:918-682-9292
Mailing Address - Fax:918-682-0054
Practice Address - Street 1:1505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2913
Practice Address - Country:US
Practice Address - Phone:918-967-4560
Practice Address - Fax:918-967-4582
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK123456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker