Provider Demographics
NPI:1063637395
Name:WARREN, CINDY GAIL (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:GAIL
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:GAIL
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:160 TREETOP CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9110
Mailing Address - Country:US
Mailing Address - Phone:502-819-8335
Mailing Address - Fax:
Practice Address - Street 1:160 TREETOP CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9110
Practice Address - Country:US
Practice Address - Phone:502-819-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000877648OtherANTHEM
KY7100303900Medicaid
KY7100303900Medicaid