Provider Demographics
NPI:1801068077
Name:MODROSIC, CYNTHIA ANN (MA, MS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:MODROSIC
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 JANE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1907
Mailing Address - Country:US
Mailing Address - Phone:636-583-4902
Mailing Address - Fax:636-583-4925
Practice Address - Street 1:427 JANE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1907
Practice Address - Country:US
Practice Address - Phone:636-583-4902
Practice Address - Fax:636-583-4925
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021117231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist