Provider Demographics
NPI:1598876484
Name:SIEFERT, DEBORAH ANN (LCSW, CHT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SIEFERT
Suffix:
Gender:F
Credentials:LCSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3965
Mailing Address - Country:US
Mailing Address - Phone:217-443-1400
Mailing Address - Fax:217-443-4727
Practice Address - Street 1:918 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3965
Practice Address - Country:US
Practice Address - Phone:217-443-1400
Practice Address - Fax:217-443-4727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL171712Medicare UPIN
IL9220867Medicare UPIN
ILK20871Medicare ID - Type Unspecified
IL285738Medicare UPIN