Provider Demographics
NPI:1467075218
Name:SELVIG, SIDNEY (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:SELVIG
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9119
Mailing Address - Country:US
Mailing Address - Phone:616-460-0392
Mailing Address - Fax:
Practice Address - Street 1:500 BARFIELD DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9018
Practice Address - Country:US
Practice Address - Phone:269-948-8041
Practice Address - Fax:269-948-9319
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker