Healthcare Provider Details

I. General information

NPI: 1639723653
Provider Name (Legal Business Name): SYDNEY MICHELLE KAY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W MICHIGAN AVE
JACKSON MI
49201-2121
US

IV. Provider business mailing address

3003 E MICHIGAN AVE # 1260
LANSING MI
48912-4616
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-7920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: