Provider Demographics
NPI:1467540872
Name:MANCINELLI, CYNTHIA JO (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JO
Last Name:MANCINELLI
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 1:5 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-3615
Mailing Address - Country:US
Mailing Address - Phone:724-228-0650
Mailing Address - Fax:
Practice Address - Street 1:1150 WASHINGTON RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9683
Practice Address - Country:US
Practice Address - Phone:724-228-0650
Practice Address - Fax:724-228-0716
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002908L235Z00000X
WVSLP-0611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist