Provider Demographics
NPI:1780269605
Name:HARRISON, SYDNIE
Entity type:Individual
Prefix:
First Name:SYDNIE
Middle Name:
Last Name:HARRISON
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 1:2020 S VETERANS BLVD APT 621
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5762
Mailing Address - Country:US
Mailing Address - Phone:225-624-8064
Mailing Address - Fax:
Practice Address - Street 1:2020 S VETERANS BLVD APT 621
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5762
Practice Address - Country:US
Practice Address - Phone:225-624-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator