Healthcare Provider Details

I. General information

NPI: 1467075218
Provider Name (Legal Business Name): SIDNEY DYKSTRA LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BARFIELD DR
HASTINGS MI
49058-9018
US

IV. Provider business mailing address

1826 140TH AVE
DORR MI
49323-9119
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8041
  • Fax: 269-948-9319
Mailing address:
  • Phone: 616-460-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: