Provider Demographics
NPI:1477389070
Name:NIMMONS, SUMMER ANN (LMSW)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:ANN
Last Name:NIMMONS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N 500 W
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5559
Mailing Address - Country:US
Mailing Address - Phone:208-681-2018
Mailing Address - Fax:
Practice Address - Street 1:254 E ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3527
Practice Address - Country:US
Practice Address - Phone:208-681-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-44588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker