Provider Demographics
NPI:1013019165
Name:SIEMENS, SANDRA S (LISW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:SIEMENS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5107
Mailing Address - Country:US
Mailing Address - Phone:563-344-7935
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD
Practice Address - Street 2:SUITE 155
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-359-7625
Practice Address - Fax:563-459-0494
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43006OtherBLUE CROSS BLUE SHIELD
IAI14314Medicare ID - Type Unspecified