Provider Demographics
NPI:1396545695
Name:SUMMERALL, LINNETTE
Entity type:Individual
Prefix:
First Name:LINNETTE
Middle Name:
Last Name:SUMMERALL
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 1:1121 WORTHINGTON WOODS BLVD STE 6064
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-1568
Mailing Address - Country:US
Mailing Address - Phone:614-204-8408
Mailing Address - Fax:
Practice Address - Street 1:1121 WORTHINGTON WOODS BLVD STE 6064
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-1568
Practice Address - Country:US
Practice Address - Phone:614-204-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children