1528476900 NPI number — MS. LA NISEIA KENDRAE CUNNINGHAM I LPC-IT

Table of content: MS. LA NISEIA KENDRAE CUNNINGHAM I LPC-IT (NPI 1528476900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528476900 NPI number — MS. LA NISEIA KENDRAE CUNNINGHAM I LPC-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
LA NISEIA
Provider Middle Name:
KENDRAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
I
Provider Credential Text:
LPC-IT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUNNINGHAM
Provider Other First Name:
LA NISEIA
Provider Other Middle Name:
KENDRAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
LPC-IT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528476900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 W BRADLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWN DEER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53223-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-371-2400
Provider Business Mailing Address Fax Number:
414-371-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 W BRADLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWN DEER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-371-2400
Provider Business Practice Location Address Fax Number:
414-371-1600
Provider Enumeration Date:
07/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2201-226 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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