Provider Demographics
NPI:1376104711
Name:WARREN, CINDY (MED,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SMITH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5700
Mailing Address - Country:US
Mailing Address - Phone:229-227-1433
Mailing Address - Fax:229-226-6353
Practice Address - Street 1:1102 SMITH AVE STE C
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5700
Practice Address - Country:US
Practice Address - Phone:229-227-1433
Practice Address - Fax:229-226-6353
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17194235Z00000X
GA010531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist