Provider Demographics
NPI:1447306246
Name:PAULK, CYNTHIA JEAN (MS CCC- SLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JEAN
Last Name:PAULK
Suffix:
Gender:F
Credentials:MS CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9826 WATERSHED DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-0911
Mailing Address - Country:US
Mailing Address - Phone:904-693-8068
Mailing Address - Fax:904-693-8068
Practice Address - Street 1:9826 WATERSHED DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-0911
Practice Address - Country:US
Practice Address - Phone:904-693-8068
Practice Address - Fax:904-693-8068
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist