Provider Demographics
NPI:1558742361
Name:SMITH, SYDNEY NICHOLE (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:NICHOLE
Other - Last Name:OVESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36106 48TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-7908
Mailing Address - Country:US
Mailing Address - Phone:253-380-6142
Mailing Address - Fax:
Practice Address - Street 1:36106 48TH AVE S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-7908
Practice Address - Country:US
Practice Address - Phone:253-380-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC608427991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical