Provider Demographics
NPI:1295907038
Name:DAVIS, CYNTHIA PH (MED CCC SLP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:PH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:HAWARD
Other - Last Name:DEMAREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 MIDDLE ST.
Mailing Address - Street 2:P.O.BOX 45
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578
Mailing Address - Country:US
Mailing Address - Phone:508-954-9396
Mailing Address - Fax:
Practice Address - Street 1:30 FOREST RD
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1731
Practice Address - Country:US
Practice Address - Phone:508-954-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2109235Z00000X
MA631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist