Provider Demographics
NPI:1689899486
Name:SHEPHERD, CYNTHIA L (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9456
Mailing Address - Country:US
Mailing Address - Phone:260-338-0601
Mailing Address - Fax:260-637-0968
Practice Address - Street 1:2824 HUNTER RD
Practice Address - Street 2:
Practice Address - City:HUNTERTOWN
Practice Address - State:IN
Practice Address - Zip Code:46748-9456
Practice Address - Country:US
Practice Address - Phone:260-338-0601
Practice Address - Fax:260-637-0968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004329A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist