Provider Demographics
NPI:1992018840
Name:GUMUCIO, OSCAR ARMANDO (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ARMANDO
Last Name:GUMUCIO
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17108 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4340
Mailing Address - Country:US
Mailing Address - Phone:216-862-8692
Mailing Address - Fax:
Practice Address - Street 1:255 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1943
Practice Address - Country:US
Practice Address - Phone:440-891-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.8684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist