Basic Information
| Provider Information | |||||||||
| NPI: | 1184005613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIKORSKI | ||||||||
| FirstName: | JONATHON | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PHD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 NORTHLAND DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554314800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528318742 | ||||||||
| FaxNumber: | 9528311626 | ||||||||
| Practice Location | |||||||||
| Address1: | 8100 NORTHLAND DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528318742 | ||||||||
| FaxNumber: | 9528311626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2015 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10061 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 4807 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 539 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | LP6449 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.