Provider Demographics
NPI:1548835606
Name:SIDIBE, ISATU KAMARA
Entity type:Individual
Prefix:
First Name:ISATU
Middle Name:KAMARA
Last Name:SIDIBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ISATU SIDIBE
Mailing Address - Street 2:4076 NEELY ROAD
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:99073
Mailing Address - Country:US
Mailing Address - Phone:206-468-8125
Mailing Address - Fax:
Practice Address - Street 1:4076 NEELY ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT ALASKA
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1825201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical