Gum, Lisa Marie

Gum, Lisa Marie is an individual health care provider with primary practice located at 100 N Main St , Suffolk VA 23434-4529. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Gum, Lisa Marie can be contacted via phone (757) 925-6764.

Contact Information

Primary practice address
100 N Main St Suffolk VA 23434-4529
Phone: (757) 925-6764
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X West Virginia

Profile Details

NPI number 1689845109
LBN Legal business name Gum, Lisa Marie
Credentials MS,CCC/SLP
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2008
Last updated Oct 29th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689845109 NPPES
West Virginia MEDICAID 7402343000

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