Provider Demographics
NPI:1477389765
Name:NYGAARD, SYDNEY CECELIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CECELIA
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 MENTONE AVE APT 39
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3163
Mailing Address - Country:US
Mailing Address - Phone:763-248-3398
Mailing Address - Fax:
Practice Address - Street 1:3841 MENTONE AVE APT 39
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3163
Practice Address - Country:US
Practice Address - Phone:763-248-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist