Provider Demographics
NPI:1912252040
Name:SCULLEY, CYNTHIA ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:SCULLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3477
Mailing Address - Country:US
Mailing Address - Phone:509-452-2404
Mailing Address - Fax:
Practice Address - Street 1:4601 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3477
Practice Address - Country:US
Practice Address - Phone:509-452-2404
Practice Address - Fax:509-452-2409
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC601660991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical