Provider Demographics
NPI:1053889774
Name:SISSON, LAKEN J
Entity type:Individual
Prefix:MS
First Name:LAKEN
Middle Name:J
Last Name:SISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAKEN
Other - Middle Name:J
Other - Last Name:RIPPENTROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-1012
Mailing Address - Country:US
Mailing Address - Phone:815-990-5265
Mailing Address - Fax:
Practice Address - Street 1:301 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1012
Practice Address - Country:US
Practice Address - Phone:815-668-7810
Practice Address - Fax:815-714-6219
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker