Provider Demographics
NPI:1730483959
Name:SUDDUTH, CYNTHIA LYNNE (M S, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:SUDDUTH
Suffix:
Gender:F
Credentials:M S, 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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222
Mailing Address - Country:US
Mailing Address - Phone:209-813-0736
Mailing Address - Fax:
Practice Address - Street 1:1311 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95251
Practice Address - Country:US
Practice Address - Phone:209-813-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist