Individual
CYNTHIA ANN PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, CCC, SLP/L
Contact information
Practice address
400 S KENNEDY DR, SUITE 600, BRADLEY, IL 60915-2682
(815) 935-7496
(815) 935-7860
Mailing address
6345 E 2000N RD, KANKAKEE, IL 60901-7504
(815) 939-9853
(815) 935-7860
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.005338
IL
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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