Black, Sionag M
Black, Sionag M is an individual health care provider with primary practice located at 200 Front Street Suite 3D, Beaver Dam WI 53916. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Black, Sionag M can be contacted via phone (920) 885-2780.Contact Information
Primary practice address
200 Front Street Suite 3D
Beaver Dam WI 53916
Phone: (920) 885-2780
Fax: (920) 885-2788
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 1012057 | Wisconsin |
Profile Details
| NPI number | 1821049412 |
|---|---|
| LBN Legal business name | Black, Sionag M |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 16th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821049412 | NPPES |
| Wisconsin | MEDICAID | 39077100 |
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