Provider Demographics
NPI:1497999825
Name:BRADY, CYNTHA A (SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHA
Middle Name:A
Last Name:BRADY
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 1:2696 BEGONIA VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2877
Mailing Address - Country:US
Mailing Address - Phone:702-527-8944
Mailing Address - Fax:702-568-5030
Practice Address - Street 1:1820 E WARM SPRINGS RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4549
Practice Address - Country:US
Practice Address - Phone:702-527-8944
Practice Address - Fax:702-586-5030
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1292235Z00000X
IDSLP1840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSLP1840OtherIDAHO BUREAU OF OCCUPATIONAL LICENSES
NVSP-1292OtherBOARD OF EXAMINERS FOR AUDIOLOGY AND SPEECH PATHOLOGY