Provider Demographics
NPI:1366112799
Name:MILLIKAN, CYNTHIA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MILLIKAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 TRAIL MAP DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:512-627-5408
Mailing Address - Fax:
Practice Address - Street 1:9100 S. HULEN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2701
Practice Address - Country:US
Practice Address - Phone:817-263-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12769OtherTEXAS DEPT. OF LICENSING AND REGULATION
01018727OtherAMERICAN SPEECH HEARING ASSOCIATION (ASHA)