Provider Demographics
NPI:1093406936
Name:DELA ROSA, SYDNEY MORGAN PEREZ (MA)
Entity Type:Individual
Prefix:
First Name:SYDNEY MORGAN
Middle Name:PEREZ
Last Name:DELA ROSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ST HELENS AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2586
Mailing Address - Country:US
Mailing Address - Phone:585-490-8810
Mailing Address - Fax:
Practice Address - Street 1:2601 70TH AVE W STE E
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5430
Practice Address - Country:US
Practice Address - Phone:253-212-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61438951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist