Healthcare Provider Details

I. General information

NPI: 1730509902
Provider Name (Legal Business Name): DEBORAH CICHRA M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 BRIDGEHAMPTON LN
ORLANDO FL
32812-5949
US

IV. Provider business mailing address

2913 BRIDGEHAMPTON LN
ORLANDO FL
32812-5949
US

V. Phone/Fax

Practice location:
  • Phone: 407-766-5314
  • Fax:
Mailing address:
  • Phone: 407-766-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: