MEDICARE: CYNTHIA LANE SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP6164	OH

General Provider Information

NPI Number	:	1205259785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LANE SLP

Provider Business Mailing Address
First Line	:	820 BROAD BLVD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3842
Country	:	US
Telephone Number	:	330-920-1324
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 FALLS AVE
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3847
Country	:	US
Telephone Number	:	330-926-3888
Fax Number	:	330-916-6016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/04/2014

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Directions to “ CYNTHIA LANE SLP” Practice Location

Language	Start Address	Practice Location

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