Provider Demographics
NPI:1912680851
Name:KUMP, JULIE (CCC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KUMP
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GOLD AVE SW STE 680
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3260
Mailing Address - Country:US
Mailing Address - Phone:505-999-0203
Mailing Address - Fax:
Practice Address - Street 1:400 GOLD AVE SW STE 680
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3260
Practice Address - Country:US
Practice Address - Phone:505-999-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1445823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist