Provider Demographics
NPI:1962077289
Name:HUMPHREY, SYDNEY LAUREN TRASK (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAUREN TRASK
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:LAUREN
Other - Last Name:TRASK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-0332
Mailing Address - Country:US
Mailing Address - Phone:207-227-6399
Mailing Address - Fax:
Practice Address - Street 1:7 GILMAN STREET
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-0475
Practice Address - Country:US
Practice Address - Phone:207-227-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist