Provider Demographics
NPI:1407486327
Name:BUMBARGER, TAYLOR RENEE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:BUMBARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 OLANTA RD
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:PA
Mailing Address - Zip Code:16863-8157
Mailing Address - Country:US
Mailing Address - Phone:814-762-9301
Mailing Address - Fax:
Practice Address - Street 1:949 OLANTA RD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:PA
Practice Address - Zip Code:16863-8157
Practice Address - Country:US
Practice Address - Phone:814-762-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL01135OtherSPEECH LANGUAGE PATHOLOGIST LICENSE