Provider Demographics
NPI:1790839546
Name:EDMISTON, CYNTHIA C (SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:EDMISTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12371 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2836
Mailing Address - Country:US
Mailing Address - Phone:713-773-5120
Mailing Address - Fax:281-288-8636
Practice Address - Street 1:12371 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2836
Practice Address - Country:US
Practice Address - Phone:713-773-5120
Practice Address - Fax:281-288-8636
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist