Provider Demographics
NPI:1689600868
Name:SIEGLER, ALLEN L JR (LICSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:L
Last Name:SIEGLER
Suffix:JR
Gender:M
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 13TH AVE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4879
Mailing Address - Country:US
Mailing Address - Phone:701-227-7533
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:300 13TH AVE W
Practice Address - Street 2:SUITE 1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4879
Practice Address - Country:US
Practice Address - Phone:701-227-7533
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND005099OtherBC/BS PIN
800006868OtherRR MEDICARE PIN
NDN5099Medicare ID - Type Unspecified
ND54523Medicaid