Provider Demographics
NPI:1265613723
Name:GIBSON, CYNTHIA (MA SLP-CCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 W SR 434 STE 108
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4953
Mailing Address - Country:US
Mailing Address - Phone:407-260-0551
Mailing Address - Fax:407-265-9590
Practice Address - Street 1:1060 W SR 434 STE 108
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4953
Practice Address - Country:US
Practice Address - Phone:407-260-0551
Practice Address - Fax:407-265-9590
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist