Provider Demographics
NPI:1558707091
Name:ROSENBERG, CYNTHIA RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ROSENBERG
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:5885 CUMMING HIGHWAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:815-520-6316
Mailing Address - Fax:
Practice Address - Street 1:1339 AVALON CREEK ROAD
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:815-520-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist