Provider Demographics
NPI:1033352430
Name:BROUILLARD, CYNTHIA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:BROUILLARD
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 1:13623 S KATY CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7042
Mailing Address - Country:US
Mailing Address - Phone:630-305-6039
Mailing Address - Fax:
Practice Address - Street 1:140 N WRIGHT ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4748
Practice Address - Country:US
Practice Address - Phone:630-305-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005745103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities