Provider Demographics
NPI:1689486144
Name:WYN, SIDNEY ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SIDNEY
Middle Name:ELIZABETH
Last Name:WYN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:ELIZABETH
Other - Last Name:BACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:828 VALLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4072
Mailing Address - Country:US
Mailing Address - Phone:517-331-5230
Mailing Address - Fax:
Practice Address - Street 1:2922 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3459
Practice Address - Country:US
Practice Address - Phone:616-570-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101009268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist