Provider Demographics
NPI:1467279943
Name:MUMM, BRENNA COLEEN NEVELS
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:COLEEN NEVELS
Last Name:MUMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 SW DANEY DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2761
Mailing Address - Country:US
Mailing Address - Phone:816-785-9432
Mailing Address - Fax:
Practice Address - Street 1:101 NW SNI A BAR PKWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-7800
Practice Address - Country:US
Practice Address - Phone:816-847-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240381322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant