Provider Demographics
NPI:1740992395
Name:LOLLIS, SYDNEE NICOLE
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:NICOLE
Last Name:LOLLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 HAPPY DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5821
Mailing Address - Country:US
Mailing Address - Phone:618-974-0431
Mailing Address - Fax:
Practice Address - Street 1:6301 HUMBERT RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2163
Practice Address - Country:US
Practice Address - Phone:618-466-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist