Provider Demographics
NPI:1790250322
Name:WAITS, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 POPLAR ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PIPERTON
Mailing Address - State:TN
Mailing Address - Zip Code:38017-5144
Mailing Address - Country:US
Mailing Address - Phone:901-246-8934
Mailing Address - Fax:
Practice Address - Street 1:160 S HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4801
Practice Address - Country:US
Practice Address - Phone:901-416-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist