Basic Information
| Provider Information | |||||||||
| NPI: | 1104027622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUMP | ||||||||
| FirstName: | CHRISTIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 BLYTHE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043558484 | ||||||||
| FaxNumber: | 7043554231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 W WT HARRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282628549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048635780 | ||||||||
| FaxNumber: | 7048635786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7686 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 2202003815 | VA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.