Provider Demographics
NPI:1396513313
Name:GIBBY, SUMMER (SLP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:GIBBY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N OLSON HILL CT
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8850
Mailing Address - Country:US
Mailing Address - Phone:509-270-1829
Mailing Address - Fax:
Practice Address - Street 1:1105 N OLSON HILL CT
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8850
Practice Address - Country:US
Practice Address - Phone:509-270-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14424810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist