MEDICARE: MRS. AMBER GUMM

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	103TS0200X	School Psychologist	2007280	IL

General Provider Information

NPI Number	:	1952817306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER GUMM

Provider Business Mailing Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7045
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7045
Fax Number	:

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

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