Provider Demographics
NPI:1508294521
Name:WILEY, CYNTHIA COLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:COLE
Last Name:WILEY
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 1:310 QUAIL MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1028
Mailing Address - Country:US
Mailing Address - Phone:434-485-1271
Mailing Address - Fax:
Practice Address - Street 1:1604 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5174
Practice Address - Country:US
Practice Address - Phone:434-200-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist