Provider Demographics
NPI:1639236821
Name:GERARD, CYNTHIA J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:GERARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4410
Mailing Address - Country:US
Mailing Address - Phone:260-482-2339
Mailing Address - Fax:877-459-3403
Practice Address - Street 1:6007 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4410
Practice Address - Country:US
Practice Address - Phone:260-482-2339
Practice Address - Fax:260-482-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003279A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist