Provider Demographics
NPI:1053860874
Name:SIEMS, LAUREN STEPHANIE (CGC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:STEPHANIE
Last Name:SIEMS
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S CLOVERDALE AVE
Mailing Address - Street 2:APT 106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-6603
Mailing Address - Country:US
Mailing Address - Phone:847-345-4380
Mailing Address - Fax:
Practice Address - Street 1:328 S CLOVERDALE AVE
Practice Address - Street 2:APT 106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-6603
Practice Address - Country:US
Practice Address - Phone:847-345-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000762170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS