Provider Demographics
NPI:1760540637
Name:ARMISTEAD, CYNTHIA ANNE (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:ARMISTEAD
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3708
Mailing Address - Country:US
Mailing Address - Phone:573-578-1048
Mailing Address - Fax:573-336-3017
Practice Address - Street 1:100 BOSA DR STE E
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4833
Practice Address - Country:US
Practice Address - Phone:573-578-1048
Practice Address - Fax:573-336-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO464986819Medicaid