Provider Demographics
NPI:1013068865
Name:HERZOG, CYNTHIA (MS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 W BURNSIDE ST
Mailing Address - Street 2:UNIT 1602
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2066
Mailing Address - Country:US
Mailing Address - Phone:360-713-8818
Mailing Address - Fax:
Practice Address - Street 1:921 NW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2324
Practice Address - Country:US
Practice Address - Phone:503-227-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22540231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist