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General NPI Number Information
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NPI Number | 1386653434
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Entity Type | Individual
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Provider Name | JOSEPH M CUNNINGHAM PHD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | N84W16889 MENOMONEE AVE
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2810
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Country | US
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Telephone | 262-251-7500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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Fax |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 71005452
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2063-057
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License Number State | WI
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