Provider Demographics
NPI:1710155650
Name:BROWN, CYNTHIA LOUISE (SLP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LOUISE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4704 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-7541
Mailing Address - Country:US
Mailing Address - Phone:817-531-3267
Mailing Address - Fax:
Practice Address - Street 1:4704 LEONARD ST
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-7541
Practice Address - Country:US
Practice Address - Phone:817-531-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist