Provider Demographics
NPI:1063718781
Name:SHUMWAY, KIM ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANN
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 BLUFF PL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4548
Mailing Address - Country:US
Mailing Address - Phone:307-286-8907
Mailing Address - Fax:
Practice Address - Street 1:5525 BLUFF PL
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4548
Practice Address - Country:US
Practice Address - Phone:307-286-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist