Individual
SHANNA MARIE KURTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3100 N DRIES LN, STE 303, PEORIA, IL 61604-1265
(309) 686-9005
(309) 686-9020
Mailing address
3100 N DRIES LN, STE 303, PEORIA, IL 61604-1265
(309) 686-9005
(309) 686-9020
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071004929
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007226636
BCBS OF IL
IL
Enumeration date
08/20/2006
Last updated
05/20/2013
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