Provider Demographics
NPI:1871046417
Name:BRICKER, SYDNEY (LMT, MSCN)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:BRICKER
Suffix:
Gender:F
Credentials:LMT, MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1786
Mailing Address - Country:US
Mailing Address - Phone:925-588-1855
Mailing Address - Fax:
Practice Address - Street 1:2625 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1786
Practice Address - Country:US
Practice Address - Phone:925-588-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT# 22541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist