Provider Demographics
NPI:1164628228
Name:GLEASON, CYNTHIA TROMBETTA (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:TROMBETTA
Last Name:GLEASON
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 KEYWEST DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-2502
Mailing Address - Country:US
Mailing Address - Phone:815-838-6744
Mailing Address - Fax:
Practice Address - Street 1:1219 KEYWEST DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2502
Practice Address - Country:US
Practice Address - Phone:815-838-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist