Provider Demographics
NPI:1710499777
Name:SIEMENS, JOANNA (LPC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SIEMENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E GARDEN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2985
Mailing Address - Country:US
Mailing Address - Phone:208-771-3111
Mailing Address - Fax:208-771-3111
Practice Address - Street 1:501 E GARDEN AVE APT 6
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2985
Practice Address - Country:US
Practice Address - Phone:208-771-3111
Practice Address - Fax:208-771-3111
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional