Provider Demographics
NPI:1871600106
Name:BUMP, KIMBERLY JOY (MSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOY
Last Name:BUMP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4920
Mailing Address - Country:US
Mailing Address - Phone:971-379-6065
Mailing Address - Fax:
Practice Address - Street 1:5714 SE MILWAUKIE AVE # P5SWS
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4920
Practice Address - Country:US
Practice Address - Phone:971-379-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA15661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical