=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871851410
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY ANN CUMINS M.A., C.C.C./SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3543 OLD CONEJO RD SUITE 102-B
-----------------------------------------------------
City | NEWBURY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-522-9771
-----------------------------------------------------
Fax | 805-492-0779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3543 OLD CONEJO RD SUITE 102-B
-----------------------------------------------------
City | NEWBURY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-522-9771
-----------------------------------------------------
Fax | 805-492-0779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP 7686
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------