Provider Demographics
NPI:1104604594
Name:KLEIN, SYDNEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARBORSIDE PL APT 650
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311-3928
Mailing Address - Country:US
Mailing Address - Phone:815-677-8962
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 107
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2458
Practice Address - Country:US
Practice Address - Phone:207-596-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01159400235Z00000X
MESP4010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist