Healthcare Provider Details

I. General information

NPI: 1316353113
Provider Name (Legal Business Name): SYDNEY DEMARIS M.A. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

IV. Provider business mailing address

112 E 5TH ST
SAINT ANSGAR IA
50472-9573
US

V. Phone/Fax

Practice location:
  • Phone: 507-433-7351
  • Fax:
Mailing address:
  • Phone: 641-330-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9278
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number075179
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: