Healthcare Provider Details

I. General information

NPI: 1588587349
Provider Name (Legal Business Name): CYNTHIA JANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY JANSEN

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 E FAIRVIEW AVE
JOHNSON CITY TN
37601-2860
US

IV. Provider business mailing address

109 ELM HILL DR
JONESBOROUGH TN
37659-3813
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-6464
  • Fax:
Mailing address:
  • Phone: 815-508-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: