Provider Demographics
NPI:1275914947
Name:MICHELLE L SIEGMAN LCSW LLC
Entity Type:Organization
Organization Name:MICHELLE L SIEGMAN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SIEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-259-5844
Mailing Address - Street 1:330 N CLINTON ST
Mailing Address - Street 2:UNIT 508
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1126
Mailing Address - Country:US
Mailing Address - Phone:312-259-5844
Mailing Address - Fax:
Practice Address - Street 1:218 N JEFFERSON ST
Practice Address - Street 2:STE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1121
Practice Address - Country:US
Practice Address - Phone:312-259-5844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0132711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629208194OtherBCBS