Provider Demographics
NPI:1912552522
Name:LUALLEN, SYDNEY LYNN
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LYNN
Last Name:LUALLEN
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 1:525 N EDGELAWN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4327
Mailing Address - Country:US
Mailing Address - Phone:630-966-4211
Mailing Address - Fax:
Practice Address - Street 1:525 N EDGELAWN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4327
Practice Address - Country:US
Practice Address - Phone:630-966-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health