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General NPI Number Information
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NPI Number | 1053487009
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Entity Type | Individual
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Provider Name | CYNTHIA ANN JOHNSRUD PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2480 W 26TH AVE STE 10B
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City | DENVER
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State | CO
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Zip | 80211-5309
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Country | US
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Telephone | 303-397-0207
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Fax | 303-433-3636
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Provider Business Mailing Address
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Address Line | 2480 W 26TH AVE STE 10B
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City | DENVER
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State | CO
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Zip | 80211-5311
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Country | US
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Telephone | 303-397-0207
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Fax | 303-433-3636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1624
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 70880
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License Number State | CO
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