Provider Demographics
NPI:1831554054
Name:BUMP, DANAE (LSW)
Entity type:Individual
Prefix:MRS
First Name:DANAE
Middle Name:
Last Name:BUMP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-1331
Mailing Address - Country:US
Mailing Address - Phone:262-949-2798
Mailing Address - Fax:262-495-8689
Practice Address - Street 1:119 MILL RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9310
Practice Address - Country:US
Practice Address - Phone:262-370-5527
Practice Address - Fax:262-485-8689
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WI7101-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker