Provider Demographics
NPI:1043310089
Name:SCHNACKE, CYNTHIA LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:SCHNACKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2958
Mailing Address - Country:US
Mailing Address - Phone:785-841-6446
Mailing Address - Fax:
Practice Address - Street 1:TEAKWOOD PSYCHOLOGICAL RESOURCES
Practice Address - Street 2:2201 W. 25TH STREET, SUITE O
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047
Practice Address - Country:US
Practice Address - Phone:785-841-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0872103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060702Medicare ID - Type Unspecified