Provider Demographics
NPI:1760518948
Name:CHAMPION, CYNTHIA CARTER (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CARTER
Last Name:CHAMPION
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 1:501 BROWNBARK LN
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2761
Mailing Address - Country:US
Mailing Address - Phone:336-213-3352
Mailing Address - Fax:336-446-4206
Practice Address - Street 1:501 BROWNBARK LN
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2761
Practice Address - Country:US
Practice Address - Phone:336-213-3352
Practice Address - Fax:336-446-4206
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412405Medicaid