Healthcare Provider Details

I. General information

NPI: 1366068272
Provider Name (Legal Business Name): SYDNEY ELISE UMANZOR M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12817 N 50TH LN
GLENDALE AZ
85304-2009
US

IV. Provider business mailing address

12817 N 50TH LN
GLENDALE AZ
85304-2009
US

V. Phone/Fax

Practice location:
  • Phone: 425-232-9613
  • Fax:
Mailing address:
  • Phone: 425-232-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP15379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: