Provider Demographics
NPI:1184005613
Name:SIKORSKI, JONATHON DAVID (PHD, LP)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:DAVID
Last Name:SIKORSKI
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4800
Mailing Address - Country:US
Mailing Address - Phone:952-831-8742
Mailing Address - Fax:952-831-1626
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431
Practice Address - Country:US
Practice Address - Phone:952-831-8742
Practice Address - Fax:952-831-1626
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10061101YM0800X
NE4807101YM0800X
NE539101YM0800X
MNLP6449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health