MEDICARE: MS. MELISSA MUMPER BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	MHI85341	MO

General Provider Information

NPI Number	:	1205256070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA MUMPER BCBA

Provider Business Mailing Address
First Line	:	424 PENINSULA AVE
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-1653
Country	:	US
Telephone Number	:	650-286-4396
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 E GREGORY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1117
Country	:	US
Telephone Number	:	650-286-4396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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