| Doctor Name: | MS. KELLY SUMMERS |
| NPI Number: | 1912217480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 302446 |
| Business Practice Address: | 950 County Highway 10 108 Spring Lake Park, MN - 554321253 |
| Business Phone Number: | 7633555092 |
| Business Fax Number: | |
| Mailing Address: | 950 County Highway 10, 108 SPRING LAKE PARK |
| State: | MN |
| Postal Code: | 554321253 |
| Phone Number: | 7633555092 |
| Fax Number: | |
| NPI Enumeration Date: | 10/18/2010 |
| NPI Last Update Date: | 10/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302446 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |