Provider Demographics
NPI:1932688983
Name:SIEVERT, MARILYN E (MS, LLP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:E
Last Name:SIEVERT
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 W STADIUM BLVD STE 203C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5291
Mailing Address - Country:US
Mailing Address - Phone:734-913-1093
Mailing Address - Fax:
Practice Address - Street 1:1785 W STADIUM BLVD STE 203C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5291
Practice Address - Country:US
Practice Address - Phone:734-913-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009228103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical