Provider Demographics
NPI:1821870288
Name:PROFFITT, SUMMER DAWN
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-9612
Mailing Address - Country:US
Mailing Address - Phone:573-223-7649
Mailing Address - Fax:
Practice Address - Street 1:5 SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9612
Practice Address - Country:US
Practice Address - Phone:573-223-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician