Provider Demographics
NPI:1023642519
Name:HARTFORD, SUMMER DAWN
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:HARTFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:DAWN
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 56525
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-1525
Mailing Address - Country:US
Mailing Address - Phone:907-687-7017
Mailing Address - Fax:
Practice Address - Street 1:3101 LATHROP ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7426
Practice Address - Country:US
Practice Address - Phone:907-459-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician