Healthcare Provider Details

I. General information

NPI: 1538897822
Provider Name (Legal Business Name): DANA RAE GUMNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD
WAUSAU WI
54401-4102
US

IV. Provider business mailing address

221902 COUNTY ROAD B
MARATHON WI
54448-7508
US

V. Phone/Fax

Practice location:
  • Phone: 800-283-2881
  • Fax:
Mailing address:
  • Phone: 608-739-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6051-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: