Provider Demographics
NPI:1285452698
Name:PELLETIER, SYDNEY LAUREN
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAUREN
Last Name:PELLETIER
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 1:3906 LIVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-7384
Mailing Address - Country:US
Mailing Address - Phone:949-887-1124
Mailing Address - Fax:
Practice Address - Street 1:3906 LIVINGSTON DR
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-7384
Practice Address - Country:US
Practice Address - Phone:949-887-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist