Provider Demographics
NPI:1407605603
Name:SIUM, BISIRAT (LSW)
Entity type:Individual
Prefix:
First Name:BISIRAT
Middle Name:
Last Name:SIUM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 APOLLO AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5941
Mailing Address - Country:US
Mailing Address - Phone:808-428-0886
Mailing Address - Fax:
Practice Address - Street 1:5135 PEARSON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5346
Practice Address - Country:US
Practice Address - Phone:808-428-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802087104100000X
HILSW-3202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker