Provider Demographics
NPI:1407999873
Name:ADDIE, CYNTHIA SUE (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:ADDIE
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 1:7555 GOAT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-7875
Mailing Address - Country:US
Mailing Address - Phone:317-373-1580
Mailing Address - Fax:317-831-2270
Practice Address - Street 1:7555 GOAT HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-7875
Practice Address - Country:US
Practice Address - Phone:317-373-1580
Practice Address - Fax:317-831-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001216A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist