Provider Demographics
NPI:1427813096
Name:KURTZ, SYDNEY LEE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LEE
Last Name:KURTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1760
Mailing Address - Country:US
Mailing Address - Phone:312-291-1595
Mailing Address - Fax:708-401-0468
Practice Address - Street 1:2432 WOOD ST
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1760
Practice Address - Country:US
Practice Address - Phone:312-291-1595
Practice Address - Fax:708-401-0468
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health