Provider Demographics
NPI:1073277711
Name:MOON, SYDNEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:MOBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:986 17 1/2 ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5425
Mailing Address - Country:US
Mailing Address - Phone:530-913-9373
Mailing Address - Fax:
Practice Address - Street 1:140 ELTON HILLS LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3567
Practice Address - Country:US
Practice Address - Phone:507-722-1508
Practice Address - Fax:507-208-7735
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist