Healthcare Provider Details

I. General information

NPI: 1912284753
Provider Name (Legal Business Name): MRS. CYNTHIA P WYCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27043 BAKER POTTS RD
HARLINGEN TX
78552-3761
US

IV. Provider business mailing address

27043 BAKER POTTS RD
HARLINGEN TX
78552-3761
US

V. Phone/Fax

Practice location:
  • Phone: 956-230-3301
  • Fax:
Mailing address:
  • Phone: 956-230-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number36395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: