Provider Demographics
NPI:1750139150
Name:WILLIAMSON, SYDNEY ROSE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ROSE
Last Name:WILLIAMSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 W RIFLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8324
Mailing Address - Country:US
Mailing Address - Phone:208-240-1333
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER STE 320
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-608-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health