Provider Demographics
NPI:1790075372
Name:SIEPEL, KATHLEEN E (MA,)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:SIEPEL
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STATE ST
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1814
Mailing Address - Country:US
Mailing Address - Phone:814-461-9072
Mailing Address - Fax:
Practice Address - Street 1:1001 STATE ST
Practice Address - Street 2:SUITE 1109
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1814
Practice Address - Country:US
Practice Address - Phone:814-461-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004967L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist