Provider Demographics
NPI:1609634609
Name:MOCABEE-SISCO, SHARON (MRC,CRC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MOCABEE-SISCO
Suffix:
Gender:F
Credentials:MRC,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3950
Mailing Address - Country:US
Mailing Address - Phone:701-483-6017
Mailing Address - Fax:701-483-5018
Practice Address - Street 1:33 9TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3950
Practice Address - Country:US
Practice Address - Phone:701-483-6017
Practice Address - Fax:701-483-5018
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
584855225C00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor