1629007521 NPI number — MS. CYDNEY MCDONALD MEDFORD MS CCC SLP

Table of content: MS. CYDNEY MCDONALD MEDFORD MS CCC SLP (NPI 1629007521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629007521 NPI number — MS. CYDNEY MCDONALD MEDFORD MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDFORD
Provider First Name:
CYDNEY
Provider Middle Name:
MCDONALD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDFORD
Provider Other First Name:
CYDNEY
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629007521
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:
1 UNIVERSITY STATION A1100
Provider Second Line Business Mailing Address:
CMA 2 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-471-3841
Provider Business Mailing Address Fax Number:
512-232-1804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2504 A WHITIS
Provider Second Line Business Practice Location Address:
CMA 2 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-471-3841
Provider Business Practice Location Address Fax Number:
512-232-1804
Provider Enumeration Date:
07/02/2006

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: 235Z00000X , with the licence number:  10244 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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