Provider Demographics
NPI:1336794361
Name:SUMMER-WEISS, SAVANNAH (LCSW)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:SUMMER-WEISS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 MAROONGLEN CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6810
Mailing Address - Country:US
Mailing Address - Phone:719-440-2809
Mailing Address - Fax:
Practice Address - Street 1:441 MANITOU AVE STE 202
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2334
Practice Address - Country:US
Practice Address - Phone:719-440-2809
Practice Address - Fax:719-440-2809
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
COCSW.099261391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONAMedicaid