Provider Demographics
NPI:1255575254
Name:SIRES, NICOLE LEE (CSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:SIRES
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ASPEN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW ALBIN
Mailing Address - State:IA
Mailing Address - Zip Code:52160
Mailing Address - Country:US
Mailing Address - Phone:563-544-4496
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8694-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator