Healthcare Provider Details

I. General information

NPI: 1417522699
Provider Name (Legal Business Name): PATRICIA MARIE KURZROCK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17205 S ROUTE 59
PLAINFIELD IL
60586-9276
US

IV. Provider business mailing address

655 W IRVING PARK RD APT 4304
CHICAGO IL
60613-6300
US

V. Phone/Fax

Practice location:
  • Phone: 815-970-9010
  • Fax:
Mailing address:
  • Phone: 773-304-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180017963
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180017963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: