Provider Demographics
NPI:1457458184
Name:CUNNINGHAM, LAUREN LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LISA
Last Name:CUNNINGHAM
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 1:1619 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2063
Mailing Address - Country:US
Mailing Address - Phone:608-255-9330
Mailing Address - Fax:608-255-7810
Practice Address - Street 1:1619 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2063
Practice Address - Country:US
Practice Address - Phone:608-255-9330
Practice Address - Fax:608-255-7810
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2301-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical