Provider Demographics
NPI:1841329562
Name:HEROLD, CINDY ALLISON (MA CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:ALLISON
Last Name:HEROLD
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3821
Mailing Address - Country:US
Mailing Address - Phone:813-731-8332
Mailing Address - Fax:
Practice Address - Street 1:473 MARMORA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3821
Practice Address - Country:US
Practice Address - Phone:813-731-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6503235Z00000X
NC6402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888915500Medicaid