Provider Demographics
NPI:1639293111
Name:KURZYDLO, KIMBERLY (LCPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KURZYDLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RIDGE RD
Mailing Address - Street 2:SUITE 1SW
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1933
Mailing Address - Country:US
Mailing Address - Phone:708-794-6511
Mailing Address - Fax:708-249-0022
Practice Address - Street 1:900 RIDGE RD
Practice Address - Street 2:SUITE 1SW
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1933
Practice Address - Country:US
Practice Address - Phone:708-794-6511
Practice Address - Fax:708-249-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional