Provider Demographics
NPI:1013321355
Name:SEIDL, LIA PATRICE
Entity Type:Individual
Prefix:MISS
First Name:LIA
Middle Name:PATRICE
Last Name:SEIDL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 232ND AVE NW APT 104
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-7810
Mailing Address - Country:US
Mailing Address - Phone:763-333-4748
Mailing Address - Fax:
Practice Address - Street 1:3832 232ND AVE NW APT 104
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-7810
Practice Address - Country:US
Practice Address - Phone:763-333-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst