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Contact Information

SIONAG M BLACK, PHD
200 FRONT STREET
SUITE 3D
BEAVER DAM, WI53916
 Phone: 920-885-2780
 Fax: 920-885-2788
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for SIONAG M BLACK · (Female)

NPI # 1821049412
Status Active
Credentials PHD
Entity Individual
Enumeration date 05/16/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 1012057
  • WI Medicaid 39077100
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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