Provider Demographics
NPI:1336272467
Name:MCCUMBER, LILLIAN MARY (MS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:MARY
Last Name:MCCUMBER
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 OATMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6168
Mailing Address - Country:US
Mailing Address - Phone:928-758-6871
Mailing Address - Fax:928-758-6834
Practice Address - Street 1:1004 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5946
Practice Address - Country:US
Practice Address - Phone:928-758-6871
Practice Address - Fax:928-758-6834
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#SLPL4986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist