Provider Demographics
NPI:1942351531
Name:PARKER-NEIS, CYNTHIA RAE (MS LP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:RAE
Last Name:PARKER-NEIS
Suffix:
Gender:F
Credentials:MS LP
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:RAE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LP
Mailing Address - Street 1:1111 CEDAR RIDGE LN SW
Mailing Address - Street 2:
Mailing Address - City:ORONOCO
Mailing Address - State:MN
Mailing Address - Zip Code:55960-1326
Mailing Address - Country:US
Mailing Address - Phone:507-250-2605
Mailing Address - Fax:
Practice Address - Street 1:1111 CEDAR RIDGE LN SW
Practice Address - Street 2:
Practice Address - City:ORONOCO
Practice Address - State:MN
Practice Address - Zip Code:55960-1326
Practice Address - Country:US
Practice Address - Phone:507-250-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3663103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM112D8PA, 32Q95PAOtherBCBS
MN145013OtherMAYO MANAGEMENT INS.
MN64981400OtherMEDICAL ASSISTANCE, DHS,