Provider Demographics
NPI:1437921723
Name:EDE, SYDNEY JEAN
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JEAN
Last Name:EDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W384 ALBANY P
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-7440
Mailing Address - Country:US
Mailing Address - Phone:715-450-1257
Mailing Address - Fax:
Practice Address - Street 1:W384 ALBANY P
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-7440
Practice Address - Country:US
Practice Address - Phone:715-450-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer