Provider Demographics
NPI:1215009840
Name:BAKER, CYNTHIA BREID (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BREID
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:207 E. 5TH STREET
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-0806
Mailing Address - Country:US
Mailing Address - Phone:417-926-3177
Mailing Address - Fax:417-926-3177
Practice Address - Street 1:207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1660
Practice Address - Country:US
Practice Address - Phone:417-926-3177
Practice Address - Fax:417-926-3177
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist