Provider Demographics
NPI:1538363346
Name:FONTENOT, CINDY PENNINGTON (SLP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:PENNINGTON
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-0224
Mailing Address - Country:US
Mailing Address - Phone:409-313-6352
Mailing Address - Fax:409-670-1457
Practice Address - Street 1:4201 FM 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1272
Practice Address - Country:US
Practice Address - Phone:409-670-1457
Practice Address - Fax:409-670-1457
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist