Provider Demographics
NPI:1275242653
Name:SUMP, DELANEY ROSE (MS, CPT)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:ROSE
Last Name:SUMP
Suffix:
Gender:F
Credentials:MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 LUCIER AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:OR
Mailing Address - Zip Code:97137-0015
Mailing Address - Country:US
Mailing Address - Phone:503-476-4550
Mailing Address - Fax:
Practice Address - Street 1:4265 LUCIER AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:OR
Practice Address - Zip Code:97137-0015
Practice Address - Country:US
Practice Address - Phone:503-476-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program