MEDICARE: KRISTIN ELIZABETH GUMZ LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW60572842	WA

General Provider Information

NPI Number	:	1639547821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH GUMZ LICSW

Provider Business Mailing Address
First Line	:	402 E YAKIMA AVE
Second Line	:	SUITE 800
City	:	YAKIMA
State	:	WA
Zip	:	98901-5407
Country	:	US
Telephone Number	:	206-817-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 E YAKIMA AVE
Second Line	:	SUITE 800
City	:	YAKIMA
State	:	WA
Zip	:	98901-5407
Country	:	US
Telephone Number	:	206-817-1310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/14/2015

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