Provider Demographics
NPI:1306165436
Name:IRELAND, CYNTHIA W (SLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
Last Name:IRELAND
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 1:1807 W DEWITT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2026
Mailing Address - Country:US
Mailing Address - Phone:501-882-7700
Mailing Address - Fax:501-882-7701
Practice Address - Street 1:1807 W DEWITT HENRY DR
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2026
Practice Address - Country:US
Practice Address - Phone:501-882-7700
Practice Address - Fax:501-882-7701
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2979235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist