Provider Demographics
NPI:1144796954
Name:STUMP, DARLA KIM (SLPA6564)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:KIM
Last Name:STUMP
Suffix:
Gender:F
Credentials:SLPA6564
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1306
Mailing Address - Country:US
Mailing Address - Phone:623-776-5123
Mailing Address - Fax:
Practice Address - Street 1:503 E CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1306
Practice Address - Country:US
Practice Address - Phone:623-776-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician