=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487083937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA MITTEAGER M.S.ED., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2013
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 WASHINGTON AVE
-----------------------------------------------------
City | COBLESKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12043-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-234-4032
-----------------------------------------------------
Fax | 518-294-6425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2133 COUNTY HIGHWAY 10
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13796-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-434-6276
-----------------------------------------------------
Fax | 518-294-6425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 022652-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------