Provider Demographics
NPI:1437270956
Name:GERVAIS, CYNTHIA A
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GERVAIS
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 1:8251 N FAWN LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8251 N FAWN LAKE RD NE
Practice Address - Street 2:
Practice Address - City:STACY
Practice Address - State:MN
Practice Address - Zip Code:55079-3201
Practice Address - Country:US
Practice Address - Phone:612-817-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist