Provider Demographics
NPI:1013091560
Name:OLIVER, CYNTHIA MERLE (MSSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MERLE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MSSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 CAGUA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2537
Mailing Address - Country:US
Mailing Address - Phone:505-888-4469
Mailing Address - Fax:
Practice Address - Street 1:3530 PAN AMERICAN FWY NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4793
Practice Address - Country:US
Practice Address - Phone:505-888-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist