Provider Demographics
NPI:1083887608
Name:CUMLEY, GARY DEAN (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:PROF
First Name:GARY
Middle Name:DEAN
Last Name:CUMLEY
Suffix:
Gender:M
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1909
Mailing Address - Country:US
Mailing Address - Phone:715-346-4699
Mailing Address - Fax:715-346-2157
Practice Address - Street 1:1901 4TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1909
Practice Address - Country:US
Practice Address - Phone:715-346-4699
Practice Address - Fax:715-346-2157
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1226154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1226154Medicaid