Provider Demographics
NPI:1275974578
Name:CUNNINGHAM, ELIZABETH ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1442 STONEBRIDGE CIR APT I8
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7188
Mailing Address - Country:US
Mailing Address - Phone:419-233-3149
Mailing Address - Fax:
Practice Address - Street 1:144 N COURT ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1224
Practice Address - Country:US
Practice Address - Phone:815-288-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health