Healthcare Provider Details

I. General information

NPI: 1649280355
Provider Name (Legal Business Name): LINDA SUE GUMP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E ONEIDA ST
OSWEGO NY
13126-2218
US

IV. Provider business mailing address

12 MALLARD LN
OSWEGO NY
13126-6406
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-2558
  • Fax: 315-342-2046
Mailing address:
  • Phone: 315-342-9549
  • Fax: 315-342-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: