Provider Demographics
NPI:1417595695
Name:LEGERE, CYNTHIA KAY
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:KAY
Last Name:LEGERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 HAWTHORNE AVE SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-6884
Mailing Address - Country:US
Mailing Address - Phone:503-589-4046
Mailing Address - Fax:503-480-0484
Practice Address - Street 1:670 HAWTHORNE AVE SE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-6884
Practice Address - Country:US
Practice Address - Phone:503-589-4046
Practice Address - Fax:503-480-0484
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health