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General NPI Number Information
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NPI Number | 1750602280
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Entity Type | Individual
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Provider Name | CYNTHIA J STALEY MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 4343 STATE HIGHWAY 14
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City | CHRISTOPHER
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State | IL
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Zip | 62822-0140
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Country | US
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Telephone | 618-724-7456
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Fax | 618-724-7492
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Provider Business Mailing Address
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Address Line | PO BOX 140 4343 STATE HIGHWAY 14
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City | CHRISTOPHER
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State | IL
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Zip | 62822-0140
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Country | US
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Telephone | 618-724-7456
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Fax | 618-724-7492
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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 | 146005942
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License Number State | IL
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