Provider Demographics
NPI:1801572938
Name:SALLAN, SYDNEE (MSW)
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:
Last Name:SALLAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22102 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2595
Mailing Address - Country:US
Mailing Address - Phone:248-763-9005
Mailing Address - Fax:
Practice Address - Street 1:22102 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-2595
Practice Address - Country:US
Practice Address - Phone:248-763-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801109722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health