Provider Demographics
NPI:1457189045
Name:CUNNINGHAM, NATALIE ROSE (APSW)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:ROSE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10695 ENTERPRISE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELCHO
Mailing Address - State:WI
Mailing Address - Zip Code:54428-9560
Mailing Address - Country:US
Mailing Address - Phone:715-351-0882
Mailing Address - Fax:
Practice Address - Street 1:1415 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2636
Practice Address - Country:US
Practice Address - Phone:715-351-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134993-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker