1609165901 NPI number — KELSEY NICOLE SIEGEL MSW, CAPSW

Table of content: KELSEY NICOLE SIEGEL MSW, CAPSW (NPI 1609165901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609165901 NPI number — KELSEY NICOLE SIEGEL MSW, CAPSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEGEL
Provider First Name:
KELSEY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, CAPSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609165901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6333 ODANA RD
Provider Second Line Business Mailing Address:
SUITE 20, ORION FAMILY SERVICES
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
53719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-270-2511
Provider Business Mailing Address Fax Number:
608-270-0467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 TOMPKINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53716-3272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-333-9190
Provider Business Practice Location Address Fax Number:
608-826-8024
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  128091-121 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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