Provider Demographics
NPI:1316353113
Name:DEMARIS, SYDNEY (MA SLP)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:
Last Name:DEMARIS
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-9573
Mailing Address - Country:US
Mailing Address - Phone:641-330-6425
Mailing Address - Fax:
Practice Address - Street 1:1810 4TH ST SW STE 103
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-4389
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9278235Z00000X
IA075179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist