Individual provider Active NPI

Sydney E Kelly, CCC-SLP

  • Speech-Language Pathologist
  • Grand Rapids, MI
National Provider Identifier
1336797786
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7101005803 Issued in MI
Practice address
2563 Rosewater Dr NE Unit 108
Grand Rapids, MI 49525-2983
Phone
(231) 675-9222
NPI assigned
Aug 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7101005803 MI Primary

Addresses

Primary practice location

2563 Rosewater Dr NE Unit 108
Grand Rapids, MI 49525-2983

Mailing address

2563 Rosewater Dr NE Unit 108
Grand Rapids, MI 49525-2983
Phone (231) 675-9222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7101005803MIMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1336797786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2563 ROSEWATER DR NE UNIT 108",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495252983",
            "telephone_number": "231-675-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2563 ROSEWATER DR NE UNIT 108",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495252983",
            "telephone_number": "231-675-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SYDNEY",
        "middle_name": "E",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101005803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.