Individual
KEN JAMES SUMMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LMFT
Contact information
Practice address
3101 AIRPORT RD, BLOOMINGTON, IL 61704-8465
(308) 846-5901
Mailing address
1101 BROADMOOR DR, BLOOMINGTON, IL 61704-6111
(309) 846-5901
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166.000929
IL
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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