MEDICARE: MAISIE WUMMER

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	235Z00000X	Speech-Language Pathologist	SL011802	PA

General Provider Information

NPI Number	:	1760898928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAISIE WUMMER

Provider Business Mailing Address
First Line	:	1904 VAN REED RD
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 VAN REED RD
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3354
Country	:	US
Telephone Number	:	610-780-6833
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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Directions to “ MAISIE WUMMER ” Practice Location

Language	Start Address	Practice Location

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