Provider Demographics
NPI:1619205424
Name:COLEMAN, SUMMER H (LICSW)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:H
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:166 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4654
Mailing Address - Country:US
Mailing Address - Phone:865-214-2507
Mailing Address - Fax:
Practice Address - Street 1:166 19TH ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4654
Practice Address - Country:US
Practice Address - Phone:865-214-2507
Practice Address - Fax:865-374-7129
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN271431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical