Provider Demographics
NPI:1821581521
Name:ENGELE, SYDNEY J (PSYD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:J
Last Name:ENGELE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10871 ELKENDIER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-3203
Mailing Address - Country:US
Mailing Address - Phone:618-314-0797
Mailing Address - Fax:
Practice Address - Street 1:10871 ELKENDIER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-3203
Practice Address - Country:US
Practice Address - Phone:618-314-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071022311103TC0700X
106S00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program