Provider Demographics
NPI:1396148532
Name:RUMBAUGH, LISA ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:RUMBAUGH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STAHR LN
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9447
Mailing Address - Country:US
Mailing Address - Phone:330-262-6823
Mailing Address - Fax:
Practice Address - Street 1:9058 DOVER ROAD
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9447
Practice Address - Country:US
Practice Address - Phone:330-698-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist