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Individual

LISA MARIE GUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS,CCC/SLP

Contact information

Practice address
100 N MAIN ST, SUFFOLK, VA 23434-4529
(757) 925-6764
Mailing address
100 N MAIN ST, SUFFOLK, VA 23434-4529
(757) 925-6764

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
WV
235Z00000X
Speech-Language Pathologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7402343000
WV
Enumeration date
03/13/2008
Last updated
10/29/2018
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