Healthcare Provider Details

I. General information

NPI: 1467997577
Provider Name (Legal Business Name): RAMYA KUMAR MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 06/29/2024
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16845 N 29TH AVE STE 1334
PHOENIX AZ
85053-0409
US

IV. Provider business mailing address

33608 N 23RD DR
PHOENIX AZ
85085-6058
US

V. Phone/Fax

Practice location:
  • Phone: 978-985-7835
  • Fax:
Mailing address:
  • Phone: 978-985-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP8131
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-301768
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: