Healthcare Provider Details

I. General information

NPI: 1386579555
Provider Name (Legal Business Name): SYDNEY WHITE LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 OAKWOOD MALL DR STE 700
EAU CLAIRE WI
54701-2617
US

IV. Provider business mailing address

306 JEFFERSON ST
EAU CLAIRE WI
54701-3955
US

V. Phone/Fax

Practice location:
  • Phone: 608-397-4315
  • Fax:
Mailing address:
  • Phone: 608-397-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9083-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: