Provider Demographics
NPI:1740755024
Name:SUMMERS, DALE KERRIN LOUISE (SLP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:KERRIN LOUISE
Last Name:SUMMERS
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 1:1912 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2601
Mailing Address - Country:US
Mailing Address - Phone:630-618-8197
Mailing Address - Fax:
Practice Address - Street 1:66 MILLER DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5144
Practice Address - Country:US
Practice Address - Phone:630-907-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242005166OtherILLINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION