1720404528 NPI number — MRS. CYNTHIA LYNETTE FOUNTAIN SLP

Table of content: MRS. CYNTHIA LYNETTE FOUNTAIN SLP (NPI 1720404528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720404528 NPI number — MRS. CYNTHIA LYNETTE FOUNTAIN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOUNTAIN
Provider First Name:
CYNTHIA
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOUNTAIN
Provider Other First Name:
CINDY
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720404528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 TAOS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXAHACHIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75165-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-689-6263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 LONE STAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75212-6313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-467-9787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2014

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:  19368 , 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)





Copyright © 2007-2025 www.npivalidator.com