Provider Demographics
NPI:1245080803
Name:GRANT, CYNDA CHRISTINE (SLP)
Entity type:Individual
Prefix:
First Name:CYNDA
Middle Name:CHRISTINE
Last Name:GRANT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CYNDA
Other - Middle Name:CHRISTINE
Other - Last Name:LAWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-2109
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:479-967-2876
Practice Address - Street 1:918 S MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4220
Practice Address - Country:US
Practice Address - Phone:479-373-6033
Practice Address - Fax:479-967-2876
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist