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General NPI Number Information
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NPI Number | 1639293111
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Entity Type | Individual
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Provider Name | KIMBERLY KURZYDLO LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 900 RIDGE RD SUITE 1SW
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City | HOMEWOOD
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State | IL
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Zip | 60430-1933
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Country | US
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Telephone | 708-794-6511
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Fax | 708-249-0022
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Provider Business Mailing Address
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Address Line | 900 RIDGE RD SUITE 1SW
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City | HOMEWOOD
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State | IL
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Zip | 60430-1933
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Country | US
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Telephone | 708-794-6511
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Fax | 708-249-0022
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180004639
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License Number State | IL
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