Healthcare Provider Details

I. General information

NPI: 1124421185
Provider Name (Legal Business Name): STACEY LYNN BUMP LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 BARNARD RD
SAGINAW MI
48603-1308
US

IV. Provider business mailing address

1500 WEISS ST
SAGINAW MI
48602-5251
US

V. Phone/Fax

Practice location:
  • Phone: 989-497-2500
  • Fax: 989-321-4984
Mailing address:
  • Phone: 989-497-2500
  • Fax: 989-321-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: