Provider Demographics
NPI:1538657739
Name:SIVERLING, ELLEN ANN (BS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:SIVERLING
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ANN
Other - Last Name:ODEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 STEIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2674
Mailing Address - Country:US
Mailing Address - Phone:715-836-0064
Mailing Address - Fax:715-836-0065
Practice Address - Street 1:2620 STEIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2674
Practice Address - Country:US
Practice Address - Phone:715-836-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst