Provider Demographics
NPI:1528112661
Name:SUMMERLIN, CHERYL F (LMT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:F
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9054 SW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5366
Mailing Address - Country:US
Mailing Address - Phone:503-595-5407
Mailing Address - Fax:
Practice Address - Street 1:9054 SW 38TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5366
Practice Address - Country:US
Practice Address - Phone:503-595-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist