Healthcare Provider Details

I. General information

NPI: 1386461093
Provider Name (Legal Business Name): CYNTHIA SODERBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 APONI PL
MOSCOW ID
83843-0936
US

IV. Provider business mailing address

1290 INDIAN HILLS DR APT 101
MOSCOW ID
83843-5123
US

V. Phone/Fax

Practice location:
  • Phone: 208-724-5733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: