Healthcare Provider Details

I. General information

NPI: 1104094192
Provider Name (Legal Business Name): CYNTHIA J HARMAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRANT COUNTY BOARD OF EDUCATION 204 JEFFERSON AVENUE
PETERSBURG WV
26847
US

IV. Provider business mailing address

GRANT COUNTY BOARD OF EDUCATION 204 JEFFERSON AVENUE
PETERSBURG WV
26847
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-1011
  • Fax:
Mailing address:
  • Phone: 304-257-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0236
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: