Provider Demographics
NPI:1487929345
Name:WILLOUGHBY, CINDI-MARIE DINGMAN (PSY D)
Entity type:Individual
Prefix:DR
First Name:CINDI-MARIE
Middle Name:DINGMAN
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 57TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2409
Mailing Address - Country:US
Mailing Address - Phone:773-814-1445
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:224-585-3312
Practice Address - Fax:224-585-3619
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209020034Medicare UPIN