Healthcare Provider Details

I. General information

NPI: 1174401657
Provider Name (Legal Business Name): SYDNEE MACPHAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 28TH ST SE # 1018
GRAND RAPIDS MI
49512-2049
US

IV. Provider business mailing address

1027 40TH ST SW
WYOMING MI
49509-4405
US

V. Phone/Fax

Practice location:
  • Phone: 616-885-8202
  • Fax:
Mailing address:
  • Phone: 906-286-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6851117930
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: