Provider Demographics
NPI:1033172549
Name:GILMORE, CINDY KURRASCH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:KURRASCH
Last Name:GILMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 LENOX STREET
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1339
Mailing Address - Country:US
Mailing Address - Phone:708-660-0747
Mailing Address - Fax:708-660-0746
Practice Address - Street 1:1144 LAKE STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-386-0800
Practice Address - Fax:708-660-0746
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL982140Medicare ID - Type Unspecified