Provider Demographics
NPI:1710264486
Name:SIDENSTICK, ERICA (LSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:SIDENSTICK
Suffix:
Gender:F
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15350 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1500
Mailing Address - Country:US
Mailing Address - Phone:708-687-9200
Mailing Address - Fax:708-687-9211
Practice Address - Street 1:15350 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1500
Practice Address - Country:US
Practice Address - Phone:708-687-9200
Practice Address - Fax:708-687-9211
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker