Provider Demographics
NPI:1326527201
Name:MCDONALD, SUMMER DAWN
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:MCDONALD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2290
Mailing Address - Country:US
Mailing Address - Phone:719-587-1001
Mailing Address - Fax:
Practice Address - Street 1:121 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3329
Practice Address - Country:US
Practice Address - Phone:719-275-2301
Practice Address - Fax:719-275-4131
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2859103TC0700X
CO23116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical