Provider Demographics
NPI:1295087070
Name:WIKLE-MYHRO, CYNTHIA LEE (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEE
Last Name:WIKLE-MYHRO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W COURTLAND AVE STE I
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2612
Mailing Address - Country:US
Mailing Address - Phone:509-842-6869
Mailing Address - Fax:509-290-5336
Practice Address - Street 1:1725 W COURTLAND AVE STE I
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2612
Practice Address - Country:US
Practice Address - Phone:509-842-6869
Practice Address - Fax:509-290-5336
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWI. LW.60468289101YM0800X
IDLCSW-32469101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor