Provider Demographics
NPI:1689871089
Name:SIEMS, AMANDA JILL (LSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JILL
Last Name:SIEMS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 GALENA ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-3008
Mailing Address - Country:US
Mailing Address - Phone:208-406-3683
Mailing Address - Fax:208-232-2850
Practice Address - Street 1:4815 GALENA ST
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-3008
Practice Address - Country:US
Practice Address - Phone:208-406-3683
Practice Address - Fax:208-232-2850
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-26286104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker