Provider Demographics
NPI:1588194401
Name:SIEGEL, STEVEN (LISW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-1420
Mailing Address - Country:US
Mailing Address - Phone:641-622-2543
Mailing Address - Fax:641-622-2818
Practice Address - Street 1:102 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4648
Practice Address - Country:US
Practice Address - Phone:641-682-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00938OtherLICENSE NUMBER