Provider Demographics
NPI:1730866419
Name:HILL, SIDNEY BRYCE (MSW, CSW, LMSW)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:BRYCE
Last Name:HILL
Suffix:
Gender:M
Credentials:MSW, CSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 N WESTSIDE HWY APT A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:ID
Mailing Address - Zip Code:83228-5080
Mailing Address - Country:US
Mailing Address - Phone:208-497-8305
Mailing Address - Fax:
Practice Address - Street 1:1515 N 400 E STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7595
Practice Address - Country:US
Practice Address - Phone:435-755-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13409600-3502104100000X
IDLMSW-43549104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker