Provider Demographics
NPI:1700111531
Name:SIEBER, KAITLIN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SIEBER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 AGARD AVE
Mailing Address - Street 2:SUITE 130, P.O. BOX 751
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4051
Mailing Address - Country:US
Mailing Address - Phone:269-944-1747
Mailing Address - Fax:
Practice Address - Street 1:960 AGARD AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4051
Practice Address - Country:US
Practice Address - Phone:269-944-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010916851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical