Provider Demographics
NPI:1851963532
Name:CHAMPION, SYDNEY (SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10243 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2028
Mailing Address - Country:US
Mailing Address - Phone:414-604-7212
Mailing Address - Fax:
Practice Address - Street 1:10243 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2028
Practice Address - Country:US
Practice Address - Phone:414-604-7212
Practice Address - Fax:414-604-7212
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist