Healthcare Provider Details

I. General information

NPI: 1629721493
Provider Name (Legal Business Name): WHITNEY RACHELLE MUMM SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 2ND AVE STE B
KEARNEY NE
68847-4401
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-1278
  • Fax: 308-234-1279
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2688
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: