Provider Demographics
NPI:1942937594
Name:SICORA, MADELINE (AUD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:SICORA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 1ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2225
Mailing Address - Country:US
Mailing Address - Phone:612-940-9339
Mailing Address - Fax:
Practice Address - Street 1:920 E 1ST ST STE 301
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2225
Practice Address - Country:US
Practice Address - Phone:218-249-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist