MEDICARE: EDITH F. CYMBAL M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 3144	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000310122	OTHER	OH	ANTHEM PIN NUMBER

General Provider Information

NPI Number	:	1104022151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH F. CYMBAL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	9575 CREAWOOD FRST
Second Line	:
City	:	WAITE HILL
State	:	OH
Zip	:	44094-9776
Country	:	US
Telephone Number	:	440-821-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	9575 CREAWOOD FRST
Second Line	:
City	:	WAITE HILL
State	:	OH
Zip	:	44094-9776
Country	:	US
Telephone Number	:	440-821-4336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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