Healthcare Provider Details

I. General information

NPI: 1417868506
Provider Name (Legal Business Name): SYDNEY KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4278 KLAIS DR
CLARKSTON MI
48348-2368
US

IV. Provider business mailing address

4278 KLAIS DR
CLARKSTON MI
48348-2368
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-4339
  • Fax:
Mailing address:
  • Phone: 248-821-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-17256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: