1518090208 NPI number — MRS. CYNTHIA A NIEDBALSKI LPC

Table of content: MRS. CYNTHIA A NIEDBALSKI LPC (NPI 1518090208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518090208 NPI number — MRS. CYNTHIA A NIEDBALSKI LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEDBALSKI
Provider First Name:
CYNTHIA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIFFORD
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518090208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 FOX HOLLOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63304-7626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-240-0523
Provider Business Mailing Address Fax Number:
636-240-0261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-706-9493
Provider Business Practice Location Address Fax Number:
636-240-0261
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2000150932 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372818 . This is a "MENTAL HEALTH NETWORK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 173405 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 11567580 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 479705 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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