MEDICARE: CYDNEY MARCUM

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	173080	KY

General Provider Information

NPI Number	:	1265953392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYDNEY MARCUM

Provider Business Mailing Address
First Line	:	166 HAPPY VALLEY RD
Second Line	:
City	:	SOUTH WILLIAMSON
State	:	KY
Zip	:	41503-4020
Country	:	US
Telephone Number	:	606-625-7518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 E 4TH ST STE 2
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40741-2528
Country	:	US
Telephone Number	:	606-330-0223
Fax Number	:

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

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	06/28/2017

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Directions to “ CYDNEY MARCUM ” Practice Location

Language	Start Address	Practice Location

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