Provider Demographics
NPI:1285090621
Name:COFFMAN, CINDY (SLP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83253 W HAWLEY FLATS AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNING
Mailing Address - State:NE
Mailing Address - Zip Code:68833
Mailing Address - Country:US
Mailing Address - Phone:308-538-2634
Mailing Address - Fax:
Practice Address - Street 1:83253 W HAWLEY FLATS AVE
Practice Address - Street 2:
Practice Address - City:DUNNING
Practice Address - State:NE
Practice Address - Zip Code:68833
Practice Address - Country:US
Practice Address - Phone:308-538-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid