Provider Demographics
NPI:1508179318
Name:SIGGELKOW, ALAN H (LCSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:H
Last Name:SIGGELKOW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4799
Mailing Address - Country:US
Mailing Address - Phone:262-345-5560
Mailing Address - Fax:262-345-5562
Practice Address - Street 1:W175N11120 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4799
Practice Address - Country:US
Practice Address - Phone:262-345-5560
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508179318Medicaid