Provider Demographics
NPI:1184996779
Name:CUNNINGHAM, TERESA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:S
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:S
Other - Last Name:BEDNARCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-7482
Practice Address - Fax:708-520-1996
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL576560Medicare PIN