Provider Demographics
NPI:1639641582
Name:SIEGERT, CHRISTINE MARIE (CHW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SIEGERT
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13548 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49747-9715
Mailing Address - Country:US
Mailing Address - Phone:248-330-8301
Mailing Address - Fax:
Practice Address - Street 1:ALCONA CITIZENS FOR HEALTH ALCONA HEALTH CENTER
Practice Address - Street 2:11745 US 23 SOUTH
Practice Address - City:OSSINEKE
Practice Address - State:MI
Practice Address - Zip Code:49766
Practice Address - Country:US
Practice Address - Phone:989-471-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010981191041C0700X
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical