Provider Demographics
NPI:1922718444
Name:JOHNSON, SUMMER RAINSONG
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:RAINSONG
Last Name:JOHNSON
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 1:1465 POLK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3829
Mailing Address - Country:US
Mailing Address - Phone:541-852-1689
Mailing Address - Fax:
Practice Address - Street 1:1465 POLK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3829
Practice Address - Country:US
Practice Address - Phone:541-852-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health