Provider Demographics
NPI:1467645473
Name:BUMA, KERI LYNN FLIETSTRA (MA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN FLIETSTRA
Last Name:BUMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 CORPORATE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-7607
Mailing Address - Country:US
Mailing Address - Phone:630-898-2200
Mailing Address - Fax:
Practice Address - Street 1:1245 CORPORATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-7607
Practice Address - Country:US
Practice Address - Phone:630-898-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist