Healthcare Provider Details

I. General information

NPI: 1447912852
Provider Name (Legal Business Name): CAROLYN SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5562 WOOD VALLEY DR
HASLETT MI
48840-9714
US

IV. Provider business mailing address

5562 WOOD VALLEY DR
HASLETT MI
48840-9714
US

V. Phone/Fax

Practice location:
  • Phone: 517-599-4578
  • Fax:
Mailing address:
  • Phone: 517-599-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: