Provider Demographics
NPI:1043562010
Name:MUMIE, LEONARD WILLIAM III (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:WILLIAM
Last Name:MUMIE
Suffix:III
Gender:M
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MCGUIRE RD
Mailing Address - Street 2:APT. 8
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8559
Mailing Address - Country:US
Mailing Address - Phone:570-956-9676
Mailing Address - Fax:
Practice Address - Street 1:5865 ROUTE 154
Practice Address - Street 2:
Practice Address - City:FORKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18616-8912
Practice Address - Country:US
Practice Address - Phone:570-924-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist