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Individual

DR. KYLE J CUSHING

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
2823 GLENWOOD AVE, ROCKFORD, IL 61101-3542
(815) 968-5342
(815) 968-4656
Mailing address
2823 GLENWOOD AVE, ROCKFORD, IL 61101-3542
(815) 968-5342
(815) 968-4656

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-006072
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0010126129
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/08/2006
Last updated
03/27/2019
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