Individual provider Active NPI

Sidney Elizabeth Wyn, MS CCC-SLP

  • Speech-Language Pathologist
  • Grand Rapids, MI
National Provider Identifier
1689486144
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7101009268 Issued in MI
Practice address
2922 Fuller Ave NE
Grand Rapids, MI 49505-3459
Phone
(616) 570-0925
NPI assigned
Jan 22, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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 7101009268 MI Primary

Addresses

Primary practice location

2922 Fuller Ave NE
Grand Rapids, MI 49505-3459

Mailing address

828 Valley Ave NW
Grand Rapids, MI 49504-4072
Phone (517) 331-5230

Other names 1

  • Sidney Elizabeth Bachman Former name

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)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
7101009268MIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Building Blocks Foundation, Inc Speech-Language Pathologist CurrentSince Dec 8, 2024 Accepting new patients
Building Blocks Therapy Services, LLC CurrentSince Dec 8, 2024 Accepting new patients

Locations

2922 Fuller Ave NE
Ste 107
Grand Rapids, MI 49505
Phone (248) 921-7814

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1689486144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 VALLEY AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044072",
            "telephone_number": "517-331-5230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053459",
            "telephone_number": "616-570-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYN",
        "first_name": "SIDNEY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101009268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIDNEY",
            "last_name": "BACHMAN",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Jan 22, 2025; 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.