Provider Demographics
NPI:1013635507
Name:BLACKMAN, SYDNEY LAUREN (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAUREN
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N RANDOLPH ST APT 1500
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4073
Mailing Address - Country:US
Mailing Address - Phone:267-322-1217
Mailing Address - Fax:
Practice Address - Street 1:3821 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1981
Practice Address - Country:US
Practice Address - Phone:484-395-3482
Practice Address - Fax:484-813-6530
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPENDING235Z00000X
VA2204001036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZAR122554059001OtherHIGHMARK BLUESHIELD