Provider Demographics
NPI:1205129574
Name:CARRERA, CYNTHIA ANNETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNETTE
Last Name:CARRERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2159
Mailing Address - Country:US
Mailing Address - Phone:707-343-8063
Mailing Address - Fax:707-806-0226
Practice Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2159
Practice Address - Country:US
Practice Address - Phone:707-343-8063
Practice Address - Fax:707-806-0226
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3312355S0801X
CA29198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty