Provider Demographics
NPI:1669474136
Name:WESTERGAARD, CINDY KINGRY (PHD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:KINGRY
Last Name:WESTERGAARD
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 1:300 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7553
Mailing Address - Country:US
Mailing Address - Phone:907-747-3743
Mailing Address - Fax:907-747-3130
Practice Address - Street 1:201 LINCOLN STREET SUITE 3
Practice Address - Street 2:209 MOLLER DRIVE
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835
Practice Address - Country:US
Practice Address - Phone:907-747-3743
Practice Address - Fax:907-747-3130
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK462103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS4254Medicaid
AKS39533Medicare UPIN
AKPS4254Medicaid