Provider Demographics
NPI:1205657970
Name:TOLMAN, SUMMER DAWN (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:TOLMAN
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2309
Mailing Address - Country:US
Mailing Address - Phone:541-936-8901
Mailing Address - Fax:
Practice Address - Street 1:1450 24TH AVENUE
Practice Address - Street 2:
Practice Address - City:SWEETHOME
Practice Address - State:OR
Practice Address - Zip Code:97368
Practice Address - Country:US
Practice Address - Phone:541-224-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM1386175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist