Provider Demographics
NPI:1316023716
Name:WADE MAYO, CINDY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:WADE MAYO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 KATHLEEN CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2850
Mailing Address - Country:US
Mailing Address - Phone:708-647-0527
Mailing Address - Fax:708-647-0527
Practice Address - Street 1:3001 KATHLEEN CT
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2850
Practice Address - Country:US
Practice Address - Phone:708-647-0527
Practice Address - Fax:708-647-0527
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364380714-60430-01Medicaid