Provider Demographics
NPI:1629828751
Name:OVERSTREET, CYNTHIA DURANT (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DURANT
Last Name:OVERSTREET
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 1:5208 NE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1074
Mailing Address - Country:US
Mailing Address - Phone:503-261-5535
Mailing Address - Fax:503-894-8229
Practice Address - Street 1:12402 NE MARX ST BLDG 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1053
Practice Address - Country:US
Practice Address - Phone:503-256-6500
Practice Address - Fax:503-894-8229
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR012053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist