Provider Demographics
NPI:1568197747
Name:SUMNER, CHRISTINE ELVIRA (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELVIRA
Last Name:SUMNER
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELVIRA
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1700 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7609
Mailing Address - Country:US
Mailing Address - Phone:540-845-2214
Mailing Address - Fax:
Practice Address - Street 1:3907 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917-9500
Practice Address - Country:US
Practice Address - Phone:252-457-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist