Provider Demographics
NPI:1659070381
Name:SUMMERS, ROSE ALINA (LPC-IT)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ALINA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N91W17194 APPLETON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2083
Mailing Address - Country:US
Mailing Address - Phone:414-502-7780
Mailing Address - Fax:
Practice Address - Street 1:N91W17194 APPLETON AVE STE 204
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2083
Practice Address - Country:US
Practice Address - Phone:414-502-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7028-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional