1689616195 NPI number — MRS. CYNTHIA BETTE WILCOXON EI CCC SLPL

Table of content: MRS. CYNTHIA BETTE WILCOXON EI CCC SLPL (NPI 1689616195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689616195 NPI number — MRS. CYNTHIA BETTE WILCOXON EI CCC SLPL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILCOXON
Provider First Name:
CYNTHIA
Provider Middle Name:
BETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
EI CCC SLPL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHARP
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
BETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
EI CCC SLPL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689616195
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:
21052 CLAYPOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62642-9687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-968-7276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21052 CLAYPOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62642-9687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-968-7276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2006

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 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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