Provider Demographics
NPI:1770366965
Name:SIDDALL, ANNA AGNES (T-LMFT)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:AGNES
Last Name:SIDDALL
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 30TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1906
Mailing Address - Country:US
Mailing Address - Phone:319-329-9568
Mailing Address - Fax:
Practice Address - Street 1:329 10TH AVE SE STE 301C
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2358
Practice Address - Country:US
Practice Address - Phone:319-329-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist