Provider Demographics
NPI:1568247781
Name:KURZYDLO, DEANNA (CADAC II)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:KURZYDLO
Suffix:
Gender:F
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9680 KEILMAN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9410
Mailing Address - Country:US
Mailing Address - Phone:614-477-0279
Mailing Address - Fax:
Practice Address - Street 1:9680 KEILMAN ST APT 4
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9410
Practice Address - Country:US
Practice Address - Phone:614-477-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)