Provider Demographics
NPI:1194849869
Name:JENKINS, CYNTHIA HARDY (MACCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:HARDY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MACCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:250 S RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5466
Mailing Address - Country:US
Mailing Address - Phone:407-260-0020
Mailing Address - Fax:407-260-9555
Practice Address - Street 1:250 S RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5466
Practice Address - Country:US
Practice Address - Phone:407-260-0020
Practice Address - Fax:407-260-9555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA00002180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist