Provider Demographics
NPI:1821348228
Name:SEIBERT, KATHLEEN COLLINS (MA/LCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:COLLINS
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:MA/LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:COLLINS SEIBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA/LCSW
Mailing Address - Street 1:POST OFFICE BOX 8101
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62222-8101
Mailing Address - Country:US
Mailing Address - Phone:618-977-5934
Mailing Address - Fax:
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:MEMORIAL SENIOR CARE - MEMORIAL HOSPITAL
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-257-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056431041C0700X
IL149.0062311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical