Provider Demographics
NPI:1093917619
Name:CRADLER, CYNTHIA SUE ELEY (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE ELEY
Last Name:CRADLER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:S
Other - Last Name:ELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:2705 N LEBANON ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 E WABASH ST STE 110
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-9400
Practice Address - Country:US
Practice Address - Phone:765-659-7400
Practice Address - Fax:765-569-7408
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001913A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023110Medicaid