Provider Demographics
NPI:1891430997
Name:DURRSTEIN, SYDNI (LPC-IT)
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:
Last Name:DURRSTEIN
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54744 STATE HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:FERRYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54628-7114
Mailing Address - Country:US
Mailing Address - Phone:608-317-0933
Mailing Address - Fax:
Practice Address - Street 1:1216 MARK AVE STE 6
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1199
Practice Address - Country:US
Practice Address - Phone:608-377-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19636130101YA0400X
WI5297226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)