Provider Demographics
NPI:1154768992
Name:FITZGERALD, CYNTHIA JAYNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JAYNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9333 OUTER BANKS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0195
Mailing Address - Country:US
Mailing Address - Phone:970-590-6859
Mailing Address - Fax:
Practice Address - Street 1:3030 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6792
Practice Address - Country:US
Practice Address - Phone:702-360-1137
Practice Address - Fax:702-240-1729
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0459112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist