Provider Demographics
NPI:1164860029
Name:BUELOW, SIDNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIDNE
Middle Name:
Last Name:BUELOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3303
Mailing Address - Country:US
Mailing Address - Phone:601-818-3079
Mailing Address - Fax:
Practice Address - Street 1:104 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3303
Practice Address - Country:US
Practice Address - Phone:601-818-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS35-572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist