Provider Demographics
NPI:1992479943
Name:STONE-DANIELS, SUMMER
Entity type:Individual
Prefix:MISS
First Name:SUMMER
Middle Name:
Last Name:STONE-DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12327 SW CANVASBACK WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6233
Mailing Address - Country:US
Mailing Address - Phone:503-757-1936
Mailing Address - Fax:
Practice Address - Street 1:10763 SW GREENBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5492
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
ORT-22-1854101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician