Provider Demographics
NPI:1689399321
Name:SUMNER, KIRSTEN ANNAMARIE (ASW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANNAMARIE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0932
Mailing Address - Country:US
Mailing Address - Phone:707-267-4977
Mailing Address - Fax:
Practice Address - Street 1:2313 I ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4244
Practice Address - Country:US
Practice Address - Phone:707-296-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1103791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical