Provider Demographics
NPI:1164823480
Name:BOUTIN, CYNTHIA DARLENE (CSLPA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DARLENE
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:CSLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10266 E MANZANITA TRL
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5230
Mailing Address - Country:US
Mailing Address - Phone:928-499-8825
Mailing Address - Fax:
Practice Address - Street 1:10266 E MANZANITA TRL
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5230
Practice Address - Country:US
Practice Address - Phone:928-499-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA90942355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant