Basic Information
| Provider Information | |||||||||
| NPI: | 1780967489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTMANN | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PAULUS | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 175 FERN DR | ||||||||
| Address2: | |||||||||
| City: | CANADENSIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183257713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705957228 | ||||||||
| FaxNumber: | 5705957228 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 EAGLE VALLEY MALL | ||||||||
| Address2: | |||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183011315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704241706 | ||||||||
| FaxNumber: | 5704246711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2011 | ||||||||
| LastUpdateDate: | 09/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL006095L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 394532 | 01 | PA | MEDICARE | OTHER |