Healthcare Provider Details

I. General information

NPI: 1023237450
Provider Name (Legal Business Name): CYNTHIA ROSE CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SW FRAZIER AVE
TOPEKA KS
66606-1963
US

IV. Provider business mailing address

325 SW FRAZIER AVE
TOPEKA KS
66606-1963
US

V. Phone/Fax

Practice location:
  • Phone: 785-232-5005
  • Fax: 888-972-5038
Mailing address:
  • Phone: 785-232-5005
  • Fax: 888-972-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: