Individual
MRS. KIMBERLY SISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10956 MASSASOIT AVE, CHICAGO RIDGE, IL 60415-2417
(708) 499-0409
Mailing address
10956 MASSASOIT AVE, CHICAGO RIDGE, IL 60415-2417
(708) 499-0409
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3008466782001
—
IL
Enumeration date
05/03/2007
Last updated
08/20/2007
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