Provider Demographics
NPI:1447451208
Name:CHURM, CYNTHIA (MSW LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CHURM
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:PELLINEN-CHURM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW CSW
Mailing Address - Street 1:2500 HALL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1604
Mailing Address - Country:US
Mailing Address - Phone:715-732-7700
Mailing Address - Fax:
Practice Address - Street 1:2500 HALL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1604
Practice Address - Country:US
Practice Address - Phone:715-732-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6593-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39754100Medicaid