1497999825 NPI number — CYNTHA A BRADY SLP

Table of content: CYNTHA A BRADY SLP (NPI 1497999825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497999825 NPI number — CYNTHA A BRADY SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADY
Provider First Name:
CYNTHA
Provider Middle Name:
A
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497999825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2696 BEGONIA VALLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-2877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-527-8944
Provider Business Mailing Address Fax Number:
702-568-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 E WARM SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-527-8944
Provider Business Practice Location Address Fax Number:
702-586-5030
Provider Enumeration Date:
04/29/2009

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:  SP-1292 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP1840 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SLP1840 . This is a "IDAHO BUREAU OF OCCUPATIONAL LICENSES" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: SP-1292 . This is a "BOARD OF EXAMINERS FOR AUDIOLOGY AND SPEECH PATHOLOGY" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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