Provider Demographics
NPI:1871845479
Name:GUMBINER, TRACY A (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:GUMBINER
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 1:463 S BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4119
Mailing Address - Country:US
Mailing Address - Phone:310-277-0829
Mailing Address - Fax:
Practice Address - Street 1:9744 WILSHIRE BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1828
Practice Address - Country:US
Practice Address - Phone:310-277-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist