Provider Demographics
NPI:1447526447
Name:SUMMERS, DUSTIN MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:204A
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-676-4688
Mailing Address - Fax:815-676-4498
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:204A
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8731
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:815-676-4498
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical