Individual provider Active NPI

Sydney Sever Hickman, MA

  • Speech-Language Pathologist
  • Roseville, CA
National Provider Identifier
1780193466
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
25699 Issued in CA
Practice address
151 N Sunrise Ave Ste 1105
Roseville, CA 95661-2931
Phone
(916) 771-8255
Fax
(916) 771-8211
NPI assigned
Sep 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 25699 CA Primary

Addresses

Primary practice location

151 N Sunrise Ave Ste 1105
Roseville, CA 95661-2931

Mailing address

151 N Sunrise Ave Ste 1105
Roseville, CA 95661-2931
Phone (916) 771-8255

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220629003198 IL Practitioner - Qualified Speech Language Pathologist 3173903655 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
25699CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Jun 15, 2022 Accepting new patients
Empowerme Wellness Kansas City, LLC Speech-Language Pathologist CurrentSince Jun 15, 2022 Accepting new patients
Empowerme Wellness Kansas City, LLC CurrentSince Jun 15, 2022 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Speech-Language Pathologist CurrentSince Jun 15, 2022 Accepting new patients

Locations

1021 W E St
Belleville, IL 62220
Phone (618) 233-2095

7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

Organizations & group practices 4

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": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1780193466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE STE 1105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612931",
            "telephone_number": "916-771-8255",
            "fax_number": "916-771-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE STE 1105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612931",
            "telephone_number": "916-771-8255",
            "fax_number": "916-771-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "SYDNEY",
        "middle_name": "SEVER",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "25699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.