Provider Demographics
NPI:1295248326
Name:SIEVERT, KRISTEN NICOLE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:SIEVERT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:DINNEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3510 LINCOLN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-8534
Mailing Address - Country:US
Mailing Address - Phone:515-292-9251
Mailing Address - Fax:
Practice Address - Street 1:3510 LINCOLN WAY STE 300
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-8534
Practice Address - Country:US
Practice Address - Phone:515-292-9251
Practice Address - Fax:844-895-6179
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084495103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling