Healthcare Provider Details

I. General information

NPI: 1497937031
Provider Name (Legal Business Name): CYNTHIA DOLLMAN LEGRAND CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 COUNTRY CLUB DR
HUNTINGTON WV
25705-2007
US

IV. Provider business mailing address

5333 COUNTRY CLUB DR
HUNTINGTON WV
25705-2007
US

V. Phone/Fax

Practice location:
  • Phone: 304-634-3332
  • Fax: 866-332-2962
Mailing address:
  • Phone: 304-634-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-1109
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: