Healthcare Provider Details

I. General information

NPI: 1972641587
Provider Name (Legal Business Name): CYNTHIA Y O'DONNELL MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6238
US

IV. Provider business mailing address

413 POSTON ST
RIO RICO AZ
85648-3210
US

V. Phone/Fax

Practice location:
  • Phone: 520-281-8282
  • Fax:
Mailing address:
  • Phone: 520-377-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP1613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: