Provider Demographics
NPI:1205476264
Name:KUMAR, BIRENDRA (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11133 E TOPAZ AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8251
Mailing Address - Country:US
Mailing Address - Phone:602-790-4777
Mailing Address - Fax:
Practice Address - Street 1:2012 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7305
Practice Address - Country:US
Practice Address - Phone:480-983-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist