Provider Demographics
NPI:1558032029
Name:KEIM, SYDNEY ROSE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ROSE
Last Name:KEIM
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 1:620 N ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5312
Mailing Address - Country:US
Mailing Address - Phone:254-732-2262
Mailing Address - Fax:
Practice Address - Street 1:19019 STATE HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6468
Practice Address - Country:US
Practice Address - Phone:254-732-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician