Provider Demographics
NPI:1588712616
Name:BLAIR, CYNTHA ANN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CYNTHA
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 N 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7306
Mailing Address - Country:US
Mailing Address - Phone:623-875-0419
Mailing Address - Fax:623-388-3242
Practice Address - Street 1:8924 N 104TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7306
Practice Address - Country:US
Practice Address - Phone:623-875-0419
Practice Address - Fax:623-388-3242
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 1493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ881046Medicaid