1447300728 NPI number — MARY A KARDASZ CUNNINGHAM PHD. LPC

Table of content: MARY A KARDASZ CUNNINGHAM PHD. LPC (NPI 1447300728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447300728 NPI number — MARY A KARDASZ CUNNINGHAM PHD. LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARDASZ CUNNINGHAM
Provider First Name:
MARY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD. LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARDASZ
Provider Other First Name:
MARY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447300728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 WINDERMERE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63301-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-949-5553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63301-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-947-2325
Provider Business Practice Location Address Fax Number:
636-947-5941
Provider Enumeration Date:
01/11/2007

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: 101YM0800X , with the licence number:  CS000138 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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