Provider Demographics
NPI:1225255292
Name:KUMP, BRYAN (SLP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:KUMP
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E LIBERTY ST
Mailing Address - Street 2:#304
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2920
Mailing Address - Country:US
Mailing Address - Phone:708-349-6544
Mailing Address - Fax:
Practice Address - Street 1:16170 KINGSPORT RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5602
Practice Address - Country:US
Practice Address - Phone:708-349-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist