Provider Demographics
NPI:1972308500
Name:LANDESS, SYDNEY DANIELLE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:DANIELLE
Last Name:LANDESS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 TAFT CT APT C9
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-4461
Mailing Address - Country:US
Mailing Address - Phone:765-546-2434
Mailing Address - Fax:
Practice Address - Street 1:242 TAFT CT APT C9
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-4461
Practice Address - Country:US
Practice Address - Phone:765-546-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician