Provider Demographics
NPI:1972068252
Name:RICHBURG, CYNTHIA MCCORMICK (PHD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MCCORMICK
Last Name:RICHBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANNE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMONG ST. BOX 99
Mailing Address - Street 2:WSU SPEECH LANGUAGE HEARING CLINIC
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260
Mailing Address - Country:US
Mailing Address - Phone:316-978-3289
Mailing Address - Fax:
Practice Address - Street 1:5015 E 29TH ST N ENTRANCE T
Practice Address - Street 2:WSU SPEECH LANGUAGE HEARING CLINIC
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220
Practice Address - Country:US
Practice Address - Phone:316-978-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS231H00000X
PAAT006018231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist