Provider Demographics
NPI:1821588310
Name:SIPKA, MARKO
Entity Type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:SIPKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 FOREST AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3517
Mailing Address - Country:US
Mailing Address - Phone:630-253-8765
Mailing Address - Fax:
Practice Address - Street 1:9641 W 153RD ST STE 48
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3777
Practice Address - Country:US
Practice Address - Phone:708-963-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional