Healthcare Provider Details

I. General information

NPI: 1316530405
Provider Name (Legal Business Name): MEGAN DIANE MUMPER SPEECH PATHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ACADEMY RD
PEMBROKE NH
03275-1345
US

IV. Provider business mailing address

BOOTHBY THERAPY SERVICES 806 NORTH MAIN ST
LACONIA NH
03246
US

V. Phone/Fax

Practice location:
  • Phone: 603-485-7881
  • Fax: 603-485-1824
Mailing address:
  • Phone: 603-524-9090
  • Fax: 603-524-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberP-0802
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2116
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: