Provider Demographics
NPI:1831167444
Name:SIEGEL, CURTIS A (MA LP)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:A
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:5100 GAMBLE DRIVE
Practice Address - Street 2:SUITE 100 MAIL STOP 31200A
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1582
Practice Address - Country:US
Practice Address - Phone:952-593-8777
Practice Address - Fax:952-595-6408
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN0650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN738347900Medicaid