Healthcare Provider Details

I. General information

NPI: 1336245869
Provider Name (Legal Business Name): CYNTHIA AUSTIN M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PARKWOOD AVE
CHATTANOOGA TN
37404-1730
US

IV. Provider business mailing address

507 S PALISADES DR
SIGNAL MTN TN
37377-2928
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-1533
  • Fax: 423-242-7103
Mailing address:
  • Phone: 423-886-7638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number634
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: