Provider Demographics
NPI:1194930263
Name:LOCK, CYNTHIA J (MT-BC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:LOCK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IL
Mailing Address - Zip Code:61415-9108
Mailing Address - Country:US
Mailing Address - Phone:309-465-7703
Mailing Address - Fax:
Practice Address - Street 1:1719 20TH AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IL
Practice Address - Zip Code:61415-9108
Practice Address - Country:US
Practice Address - Phone:309-465-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist