Healthcare Provider Details

I. General information

NPI: 1972289239
Provider Name (Legal Business Name): SYDNEY DANIELLE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 N NAPER BLVD STE 250
NAPERVILLE IL
60563-8830
US

IV. Provider business mailing address

1804 N NAPER BLVD STE 250
NAPERVILLE IL
60563-8830
US

V. Phone/Fax

Practice location:
  • Phone: 630-283-8839
  • Fax: 630-283-8841
Mailing address:
  • Phone: 630-283-8839
  • Fax: 630-283-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.111874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: