Provider Demographics
NPI:1386938041
Name:PUMMILL, WALTER EUGENE JR (MS)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:EUGENE
Last Name:PUMMILL
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10262 W IDA AVE
Mailing Address - Street 2:NO 242
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10262 W IDA AVE
Practice Address - Street 2:NO 242
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-2046
Practice Address - Country:US
Practice Address - Phone:573-289-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker