MEDICARE: CYNTHIA A GERVAIS

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	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1437270956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A GERVAIS

Provider Business Mailing Address
First Line	:	8251 N FAWN LAKE RD NE
Second Line	:
City	:	STACY
State	:	MN
Zip	:	55079-3201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 N FAWN LAKE RD NE
Second Line	:
City	:	STACY
State	:	MN
Zip	:	55079-3201
Country	:	US
Telephone Number	:	612-817-0440
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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Directions to “ CYNTHIA A GERVAIS ” Practice Location

Language	Start Address	Practice Location

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