Individual
CYNTHIA S WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC SLP
Contact information
Practice address
1600 SUTTER PL, CLOVIS, NM 88101-4611
(505) 769-4490
(505) 935-0011
Mailing address
2001 VIVIAN AVE, CLOVIS, NM 88101-5064
(505) 762-5046
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2735
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B6904
—
NM
Enumeration date
11/08/2006
Last updated
07/08/2007
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