Healthcare Provider Details

I. General information

NPI: 1205019007
Provider Name (Legal Business Name): SAMANTHA ELAINE SIKORSKI H.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 NUNN AVE
RICE LAKE WI
54868-1041
US

IV. Provider business mailing address

802 NUNN AVE
RICE LAKE WI
54868-1041
US

V. Phone/Fax

Practice location:
  • Phone: 715-939-1296
  • Fax: 715-939-1298
Mailing address:
  • Phone: 715-939-1296
  • Fax: 715-939-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1226-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: