Provider Demographics
NPI:1992064844
Name:O'BRIEN, CYNTHIA (BC-HIS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2979
Mailing Address - Country:US
Mailing Address - Phone:812-254-6616
Mailing Address - Fax:812-254-9110
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2979
Practice Address - Country:US
Practice Address - Phone:812-254-6616
Practice Address - Fax:812-254-9110
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001108A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist