Provider Demographics
NPI:1831791003
Name:RATLIFF, SUMMER MICHELLE (LADC, LICSW)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:MICHELLE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LADC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1426
Mailing Address - Country:US
Mailing Address - Phone:952-956-3182
Mailing Address - Fax:
Practice Address - Street 1:1100 E 80TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1426
Practice Address - Country:US
Practice Address - Phone:952-956-3182
Practice Address - Fax:612-869-3225
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN267601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty