Healthcare Provider Details

I. General information

NPI: 1265685804
Provider Name (Legal Business Name): DENA STEPHANIE SIDMORE-SEYER MS, CRC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 MESA DR
DUBUQUE IA
52001-1668
US

IV. Provider business mailing address

2615 MESA DR
DUBUQUE IA
52001-1668
US

V. Phone/Fax

Practice location:
  • Phone: 563-552-9211
  • Fax:
Mailing address:
  • Phone: 563-552-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCRC 00108799
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015569
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: