Provider Demographics
NPI:1689616195
Name:WILCOXON, CYNTHIA BETTE (EI CCC SLPL)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BETTE
Last Name:WILCOXON
Suffix:
Gender:F
Credentials:EI CCC SLPL
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:BETTE
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EI CCC SLPL
Mailing Address - Street 1:21052 CLAYPOOL ST
Mailing Address - Street 2:
Mailing Address - City:GREENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:62642-9687
Mailing Address - Country:US
Mailing Address - Phone:217-968-7276
Mailing Address - Fax:
Practice Address - Street 1:21052 CLAYPOOL ST
Practice Address - Street 2:
Practice Address - City:GREENVIEW
Practice Address - State:IL
Practice Address - Zip Code:62642-9687
Practice Address - Country:US
Practice Address - Phone:217-968-7276
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist