Provider Demographics
NPI:1629007521
Name:MEDFORD, CYDNEY MCDONALD (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CYDNEY
Middle Name:MCDONALD
Last Name:MEDFORD
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:CYDNEY
Other - Middle Name:GAYLE
Other - Last Name:MEDFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY STATION A1100
Mailing Address - Street 2:CMA 2 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:512-471-3841
Mailing Address - Fax:512-232-1804
Practice Address - Street 1:2504 A WHITIS
Practice Address - Street 2:CMA 2 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-471-3841
Practice Address - Fax:512-232-1804
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist