Provider Demographics
NPI:1588119895
Name:RUMPLE, ALESHA RENEA
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:RENEA
Last Name:RUMPLE
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 1:1323 PIEDMONT CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5604
Mailing Address - Country:US
Mailing Address - Phone:217-371-9818
Mailing Address - Fax:
Practice Address - Street 1:100 WIEMAN LN
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-5560
Practice Address - Country:US
Practice Address - Phone:636-462-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist