Provider Demographics
NPI:1245741966
Name:SIELBECK, LAURA DAWN (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DAWN
Last Name:SIELBECK
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 METROPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-2136
Mailing Address - Country:US
Mailing Address - Phone:618-524-9376
Mailing Address - Fax:
Practice Address - Street 1:401 METROPOLIS ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2136
Practice Address - Country:US
Practice Address - Phone:618-524-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL287377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL287377OtherILLINOIS TEACHER CERTIFICATION