Provider Demographics
NPI:1659150845
Name:SIEBEN, WILLIAM J
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SIEBEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-0023
Mailing Address - Country:US
Mailing Address - Phone:763-600-2911
Mailing Address - Fax:763-244-1243
Practice Address - Street 1:201 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040
Practice Address - Country:US
Practice Address - Phone:763-600-2911
Practice Address - Fax:763-244-1243
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist