Provider Demographics
NPI:1295188399
Name:KLUMP, SHANNA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:KLUMP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 SPANISH OAK CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1184
Mailing Address - Country:US
Mailing Address - Phone:410-274-0041
Mailing Address - Fax:
Practice Address - Street 1:1702 SPANISH OAK CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1184
Practice Address - Country:US
Practice Address - Phone:410-274-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist