Provider Demographics
NPI:1740279983
Name:SIKORA, JACQUELINE RENEE (LPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:SIKORA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2937
Mailing Address - Country:US
Mailing Address - Phone:724-532-1468
Mailing Address - Fax:
Practice Address - Street 1:125 HARTMAN RD
Practice Address - Street 2:STE K, BOX 9
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6463
Practice Address - Country:US
Practice Address - Phone:724-834-0916
Practice Address - Fax:724-834-0723
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1756774OtherHIGHMARK BC/BS
PA1460338OtherHIGHMARK BC/BS