Provider Demographics
NPI:1508927468
Name:WEBER, CYNTHIA JUANITA (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JUANITA
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 LORE RD
Mailing Address - Street 2:# 3
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2911
Mailing Address - Country:US
Mailing Address - Phone:907-538-3655
Mailing Address - Fax:907-929-7327
Practice Address - Street 1:2401 E 42ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-538-3655
Practice Address - Fax:907-929-7327
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK70231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3957OtherNM STATE AUDIOLOGY LICENS
AK70OtherSTATE AUDIOLOGY LICENSE
NM12409715Medicaid