Provider Demographics
NPI:1710794722
Name:SMITH, SIDNEY BAYLIES
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:BAYLIES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N KIMBALL AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1256
Mailing Address - Country:US
Mailing Address - Phone:413-884-5198
Mailing Address - Fax:
Practice Address - Street 1:2600 N KIMBALL AVE APT 311
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1256
Practice Address - Country:US
Practice Address - Phone:413-884-5198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician