Individual
AUDRA SISAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QASP, BCCS
Contact information
Practice address
7711 156TH STREET CT E, PUYALLUP, WA 98375-7653
(609) 312-8261
Mailing address
7711 156TH STREET CT E, PUYALLUP, WA 98375-7653
(609) 312-8261
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
WA
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/02/2016
Last updated
01/19/2021
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