MEDICARE: MR. DENNIS SIGO CADC 1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	99-07-30	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316274962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS SIGO CADC 1

Provider Business Mailing Address
First Line	:	3949 SOUTH 6TH ST.
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4746
Country	:	US
Telephone Number	:	541-882-1487
Fax Number	:	541-882-1670

Provider Business Practice Location Address
First Line	:	3949 SOUTH 6TH ST.
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4746
Country	:	US
Telephone Number	:	541-882-1487
Fax Number	:	541-882-1670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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