Provider Demographics
NPI:1255854378
Name:YOUNG, CYNTHIA DWYER (MS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DWYER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 BIG DALTON AVE
Mailing Address - Street 2:STE 170 #335
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706
Mailing Address - Country:US
Mailing Address - Phone:909-714-9911
Mailing Address - Fax:
Practice Address - Street 1:147 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3407
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:626-836-6927
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty