Provider Demographics
NPI:1053487009
Name:JOHNSRUD, CYNTHIA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:JOHNSRUD
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 1:2480 W 26TH AVE STE 10B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5311
Mailing Address - Country:US
Mailing Address - Phone:303-397-0207
Mailing Address - Fax:303-433-3636
Practice Address - Street 1:2480 W 26TH AVE
Practice Address - Street 2:STE 10B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5309
Practice Address - Country:US
Practice Address - Phone:303-397-0207
Practice Address - Fax:303-433-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1624103TC0700X
CO70880163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse