Provider Demographics
NPI:1568716041
Name:WILLIAMS, CYNTHIA E (SLP APPLICANT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SLP APPLICANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1101
Mailing Address - Country:US
Mailing Address - Phone:518-891-3148
Mailing Address - Fax:
Practice Address - Street 1:427 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4751
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:518-561-6367
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAPPLICANT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist