Provider Demographics
NPI:1619005246
Name:MUCKERMAN, CYNTHIA B
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:MUCKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E HIGHWAY 124
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-9346
Mailing Address - Country:US
Mailing Address - Phone:573-696-5512
Mailing Address - Fax:573-696-3606
Practice Address - Street 1:411 E HIGHWAY 124
Practice Address - Street 2:HALLSVILLE R-IV SCHOOL DISTRICT
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255-9346
Practice Address - Country:US
Practice Address - Phone:573-696-5512
Practice Address - Fax:573-696-3606
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465690014Medicaid