| Doctor Name: | CYNTHIA ANN PROVOST |
| NPI Number: | 1023366036 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MHS, CCC, SLP/L |
| License Number: | 146.005338 |
| Business Practice Address: | 400 S Kennedy Dr Suite 600 Bradley, IL - 609152682 |
| Business Phone Number: | 8159357496 |
| Business Fax Number: | 8159357860 |
| Mailing Address: | 6345 E 2000n Rd, KANKAKEE |
| State: | IL |
| Postal Code: | 609017504 |
| Phone Number: | 8159399853 |
| Fax Number: | 8159357860 |
| NPI Enumeration Date: | 08/22/2012 |
| NPI Last Update Date: | 08/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146.005338 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |