Provider Demographics
NPI:1487778742
Name:GUMP, CARA
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:GUMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:ESPOSITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 KENMORE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3218
Mailing Address - Country:US
Mailing Address - Phone:304-319-1145
Mailing Address - Fax:
Practice Address - Street 1:415 BENEDUM DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1503
Practice Address - Country:US
Practice Address - Phone:304-842-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0758235Z00000X
PASL007864235Z00000X
MD05228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist