Healthcare Provider Details

I. General information

NPI: 1992018840
Provider Name (Legal Business Name): OSCAR ARMANDO GUMUCIO MA CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 FRONT ST
BEREA OH
44017-1943
US

IV. Provider business mailing address

17108 WOODBURY AVE
CLEVELAND OH
44135-4340
US

V. Phone/Fax

Practice location:
  • Phone: 440-891-3445
  • Fax:
Mailing address:
  • Phone: 216-862-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.8684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: