Provider Demographics
NPI:1295209617
Name:WILSON, SUMMER ANN (LCSW)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:ANN
Other - Last Name:CARRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 W IOWA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2826
Mailing Address - Country:US
Mailing Address - Phone:208-867-9329
Mailing Address - Fax:
Practice Address - Street 1:430 W IOWA AVE STE B
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2826
Practice Address - Country:US
Practice Address - Phone:208-867-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-381651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty