Individual
SAMANTHA RENAE SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(503) 302-2459
Mailing address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(503) 302-2459
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
172V00000X
Community Health Worker
Primary
THW000110507
OR
Other
Enumeration date
10/15/2019
Last updated
03/12/2024
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