Provider Demographics
NPI:1356139968
Name:SIEBRECHT, DILLON SANTOS
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:SANTOS
Last Name:SIEBRECHT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-3210
Mailing Address - Country:US
Mailing Address - Phone:360-621-6083
Mailing Address - Fax:
Practice Address - Street 1:5280 PENDLETON AVE STE A0021
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433-1672
Practice Address - Country:US
Practice Address - Phone:833-747-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician