Provider Demographics
NPI:1063988103
Name:SMITH, SYDNEY ANNE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ANNE
Last Name:SMITH
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 1:13251 SE OATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7000
Mailing Address - Country:US
Mailing Address - Phone:503-545-2107
Mailing Address - Fax:
Practice Address - Street 1:13251 SE OATFIELD RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7000
Practice Address - Country:US
Practice Address - Phone:503-545-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator