Provider Demographics
NPI:1467160556
Name:WHITE, SYDNEY MADDISON
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MADDISON
Last Name:WHITE
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 1:2045 BURGESS DR UNIT 117
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8919
Mailing Address - Country:US
Mailing Address - Phone:330-347-6896
Mailing Address - Fax:
Practice Address - Street 1:131 N METZGER AVE
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1225
Practice Address - Country:US
Practice Address - Phone:330-927-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist