Provider Demographics
NPI:1467698688
Name:SIEFER, LODI
Entity Type:Individual
Prefix:
First Name:LODI
Middle Name:
Last Name:SIEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MANHATTAN DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4254
Mailing Address - Country:US
Mailing Address - Phone:303-396-7505
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4254
Practice Address - Country:US
Practice Address - Phone:303-396-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO6311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health