MEDICARE: CYNTHIA J GERARD MA, 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	22003279A	IN

General Provider Information

NPI Number	:	1639236821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA J GERARD MA, CCC-SLP

Provider Business Mailing Address
First Line	:	6007 STONEY CREEK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4410
Country	:	US
Telephone Number	:	260-482-2339
Fax Number	:	877-459-3403

Provider Business Practice Location Address
First Line	:	6007 STONEY CREEK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-4410
Country	:	US
Telephone Number	:	260-482-2339
Fax Number	:	260-482-2269

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/07/2010

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