Healthcare Provider Details

I. General information

NPI: 1700922770
Provider Name (Legal Business Name): DEBBIE J SIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E PORTAGE AVE
SAULT SAINTE MARIE MI
49783-2446
US

IV. Provider business mailing address

97 S 4TH ST STE C
ISHPEMING MI
49849-2168
US

V. Phone/Fax

Practice location:
  • Phone: 906-635-6075
  • Fax: 906-635-6549
Mailing address:
  • Phone: 906-228-9699
  • Fax: 888-977-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number68010625567
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: