Healthcare Provider Details

I. General information

NPI: 1538734546
Provider Name (Legal Business Name): SYDNI RENEE SIEGRIST MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKER RD, SUITE 100
FARMINGTON HILLS MI
48334
US

IV. Provider business mailing address

27777 INKER RD, SUITE 100
FARMINGTON HILLS MI
48334
US

V. Phone/Fax

Practice location:
  • Phone: 616-536-0074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: