Provider Demographics
NPI:1023693991
Name:BOONE, SUMMER RAYNE
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:RAYNE
Last Name:BOONE
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 1:5039 VILLA LINDE PKWY STE 30
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6296 VILLAGE SQUARE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722
Practice Address - Country:US
Practice Address - Phone:989-401-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician