Provider Demographics
NPI:1356612428
Name:SCOTT, CYNTHIA S (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29678 BAUGH ST NW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-4650
Mailing Address - Country:US
Mailing Address - Phone:612-801-3683
Mailing Address - Fax:
Practice Address - Street 1:29678 BAUGH ST NW
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4650
Practice Address - Country:US
Practice Address - Phone:612-801-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6010OtherMN DEPT OF HEALTH SPEECH PATHOLOGY LICENSE