Provider Demographics
NPI:1790096261
Name:SISK, DAVID A (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SISK
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 LINCOLN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2308
Mailing Address - Country:US
Mailing Address - Phone:773-732-5073
Mailing Address - Fax:
Practice Address - Street 1:588 LINCOLN AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2308
Practice Address - Country:US
Practice Address - Phone:773-732-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0143231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical