Provider Demographics
NPI:1619031101
Name:SUMMERS, SHERRY A (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:A
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 N 775 E
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-5063
Mailing Address - Country:US
Mailing Address - Phone:208-357-0825
Mailing Address - Fax:
Practice Address - Street 1:289 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3922
Practice Address - Country:US
Practice Address - Phone:208-233-5600
Practice Address - Fax:208-233-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1219231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist