Provider Demographics
NPI:1245957240
Name:SISK, COLLEEN IRENE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:IRENE
Last Name:SISK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 N WAYNE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5037
Mailing Address - Country:US
Mailing Address - Phone:208-635-5907
Mailing Address - Fax:208-635-5908
Practice Address - Street 1:8680 N WAYNE DR STE C
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5037
Practice Address - Country:US
Practice Address - Phone:208-635-5907
Practice Address - Fax:208-635-5908
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-21-57392103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst