Provider Demographics
NPI:1275305187
Name:ANDERSON, SYDNEY MARIE (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 FEDERAL DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6281
Mailing Address - Country:US
Mailing Address - Phone:815-459-3810
Mailing Address - Fax:815-356-3550
Practice Address - Street 1:394 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6281
Practice Address - Country:US
Practice Address - Phone:815-459-3810
Practice Address - Fax:815-356-3550
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist