Provider Demographics
NPI:1871254722
Name:JISHI, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:JISHI
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 1:6615 PINEHURST ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1983
Mailing Address - Country:US
Mailing Address - Phone:313-529-5589
Mailing Address - Fax:
Practice Address - Street 1:6615 PINEHURST ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1983
Practice Address - Country:US
Practice Address - Phone:313-529-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical