Healthcare Provider Details

I. General information

NPI: 1669622346
Provider Name (Legal Business Name): CYNTHIA M BAMAZE M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY M BAMAZE M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W 103RD ST STE 300 QUANTUM HEALTH PROFESSIONALS
OVERLAND PARK KS
66214
US

IV. Provider business mailing address

15510 CAMDEN AVE
OMAHA NE
68116-8450
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-1910
  • Fax:
Mailing address:
  • Phone: 402-320-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number09147436
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number1131
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: