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General NPI Number Information
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NPI Number | 1457801276
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Entity Type | Individual
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Provider Name | WILLIAM SISCO PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 830 COTTAGEVIEW DR STE 103
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2373
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Country | US
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Telephone | 231-631-7517
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Fax |
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Provider Business Mailing Address
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Address Line | 830 COTTAGEVIEW DR STE 103
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2373
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Country | US
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Telephone | 231-631-7517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005386
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License Number State | VA
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