Provider Demographics
NPI:1205019007
Name:SIKORSKI, SAMANTHA ELAINE (HIS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1310
Mailing Address - Country:US
Mailing Address - Phone:715-939-1296
Mailing Address - Fax:715-939-1298
Practice Address - Street 1:720 N RIVER ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1310
Practice Address - Country:US
Practice Address - Phone:715-939-1296
Practice Address - Fax:715-939-1298
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1226-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42837200Medicaid