Individual provider Active NPI

Sydney Brock

  • Behavior Technician
  • Burnsville, MN
National Provider Identifier
1508354325
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
14301 Ewing Ave S
Burnsville, MN 55306-4885
Phone
(952) 746-5350
NPI assigned
Apr 26, 2018
Last updated
Apr 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

14301 Ewing Ave S
Burnsville, MN 55306-4885

Mailing address

14301 Ewing Ave S
Burnsville, MN 55306-4885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211215000364 MN Practitioner - Occupational Therapist in Private Practice 2668863259 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Associates Inc CurrentSince Feb 9, 2024 Accepting new patients
Family Speech & Therapy Services, LLC CurrentSince Oct 18, 2021 Accepting new patients
Therapy Associates, Inc. PastSince Feb 9, 2024 Accepting new patients

Locations

1891 Station Pkwy NW
Andover, MN 55304
Phone (763) 307-4589

904 6th Avenue Ct NE
Isanti, MN 55040
Phone (763) 444-7556

11100 86th Ave N
Maple Grove, MN 55369
Phone (612) 418-4324

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524700800000",
    "number": "1508354325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14301 EWING AVE S",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553064885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14301 EWING AVE S",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553064885",
            "telephone_number": "952-746-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "SYDNEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.