Provider Demographics
NPI:1184176208
Name:CUSHMAN, CARA JEAN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:JEAN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 OLD MUEGGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3033
Mailing Address - Country:US
Mailing Address - Phone:636-443-4076
Mailing Address - Fax:636-443-4082
Practice Address - Street 1:2800 OLD MUEGGE RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3033
Practice Address - Country:US
Practice Address - Phone:636-443-4076
Practice Address - Fax:636-443-4082
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist