Provider Demographics
NPI:1598833055
Name:STUMP, KEENAN (SLP)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:STUMP
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 1:811 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1605
Mailing Address - Country:US
Mailing Address - Phone:913-549-8282
Mailing Address - Fax:816-817-0657
Practice Address - Street 1:811 E 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1605
Practice Address - Country:US
Practice Address - Phone:913-549-8282
Practice Address - Fax:816-817-0657
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist