Provider Demographics
NPI:1750433884
Name:SICKLES, SHARON DIANE (LISW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DIANE
Last Name:SICKLES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311
Mailing Address - Country:US
Mailing Address - Phone:515-971-4446
Mailing Address - Fax:
Practice Address - Street 1:6900 UNIVERSITY AVE
Practice Address - Street 2:STE 135
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311
Practice Address - Country:US
Practice Address - Phone:515-243-1020
Practice Address - Fax:515-883-1946
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker