Provider Demographics
NPI:1346557832
Name:SISKAVICH, KAREN ANGELA
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ANGELA
Last Name:SISKAVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BRASHER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13613-0307
Mailing Address - Country:US
Mailing Address - Phone:315-389-5131
Mailing Address - Fax:315-389-4651
Practice Address - Street 1:1039 STATE HIGHWAY 11C
Practice Address - Street 2:
Practice Address - City:BRASHER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13613-4104
Practice Address - Country:US
Practice Address - Phone:315-389-5131
Practice Address - Fax:315-389-4651
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011951-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist