Individual
SHANE SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
(503) 949-2927
Mailing address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
(541) 422-8687
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
13027123
WI
1041C0700X
Clinical Social Worker
134973
WI
1041C0700X
Clinical Social Worker
Primary
A15593
OR
Other
Enumeration date
09/23/2024
Last updated
06/23/2026
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