Individual
DANIELLE SISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
2330 NE SISKIYOU ST, PORTLAND, OR 97212-2471
(503) 528-0757
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
(503) 968-7711
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
10/07/2010
Last updated
09/26/2013
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