Healthcare Provider Details

I. General information

NPI: 1871690933
Provider Name (Legal Business Name): SANDRA K. SIEFKEN LPC, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40820 N TRAILHEAD WAY
ANTHEM AZ
85086-4941
US

IV. Provider business mailing address

40820 N TRAILHEAD WAY
ANTHEM AZ
85086-4941
US

V. Phone/Fax

Practice location:
  • Phone: 602-828-8783
  • Fax:
Mailing address:
  • Phone: 602-828-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC10450
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC1477
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: