Provider Demographics
NPI:1356472500
Name:DAVIDSON, CINDY (SLP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 CHARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1545
Mailing Address - Country:US
Mailing Address - Phone:316-650-2891
Mailing Address - Fax:
Practice Address - Street 1:CLEARWATER
Practice Address - Street 2:620 E WOOD STREET
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-9757
Practice Address - Country:US
Practice Address - Phone:620-584-2271
Practice Address - Fax:620-584-2277
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist