Provider Demographics
NPI:1821670886
Name:SCHRUM, SIDNEY LEAANNE
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:LEAANNE
Last Name:SCHRUM
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 1:338 BROADWAY STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701
Mailing Address - Country:US
Mailing Address - Phone:573-225-6678
Mailing Address - Fax:
Practice Address - Street 1:338 BROADWAY STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-225-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician