Provider Demographics
NPI:1649063173
Name:WILSON, SYDNEY
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60416-9437
Mailing Address - Country:US
Mailing Address - Phone:309-219-7199
Mailing Address - Fax:
Practice Address - Street 1:2635 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4339
Practice Address - Country:US
Practice Address - Phone:309-531-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist