Basic Information
| Provider Information | |||||||||
| NPI: | 1710001052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENKE | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | BECKER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 N POINTE DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224052776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403726473 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11 DAIRY LN | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224052663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403719414 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2202002530 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.