Provider Demographics
NPI:1922318831
Name:BISANG, SHARON (MACCC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BISANG
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 SPRING HILL FARM DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8420
Mailing Address - Country:US
Mailing Address - Phone:636-225-0324
Mailing Address - Fax:
Practice Address - Street 1:737 SPRING HILL FARM DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-8420
Practice Address - Country:US
Practice Address - Phone:636-225-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist