Provider Demographics
NPI:1790926871
Name:SUTHERLAND, CYNTHIA J (SLP/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748-9428
Mailing Address - Country:US
Mailing Address - Phone:309-726-1645
Mailing Address - Fax:309-451-8989
Practice Address - Street 1:1606 HUNT DR
Practice Address - Street 2:SPICE
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2192
Practice Address - Country:US
Practice Address - Phone:309-452-0069
Practice Address - Fax:309-451-8989
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist