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General NPI Number Information
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NPI Number | 1083198717
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Entity Type | Individual
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Provider Name | MRS. CYNTHIA DIANE COCKERHAM
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Gender | Female
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 326 HARDY ROAD
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City | MISSISSIPPI STATE
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State | MS
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Zip | 39762
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Country | US
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Telephone | 662-325-0876
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Fax |
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Provider Business Mailing Address
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Address Line | 40257 SELF RD
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City | HAMILTON
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State | MS
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Zip | 39746-8726
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Country | US
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Telephone | 662-251-8681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S4500
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License Number State | MS
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