Provider Demographics
NPI:1942388335
Name:FORSTER-FUEREDI, CINDY JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:JO
Last Name:FORSTER-FUEREDI
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 1:1010 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1702
Mailing Address - Country:US
Mailing Address - Phone:815-761-0970
Mailing Address - Fax:
Practice Address - Street 1:1010 GENEVA ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1702
Practice Address - Country:US
Practice Address - Phone:815-761-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359190Medicare ID - Type Unspecified