Provider Demographics
NPI:1871259721
Name:TIMM, SYDNEY MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MICHELLE
Last Name:TIMM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 JOHN HICKMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5711
Mailing Address - Country:US
Mailing Address - Phone:469-850-2909
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5711
Practice Address - Country:US
Practice Address - Phone:469-850-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX14424263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist