Healthcare Provider Details

I. General information

NPI: 1720999295
Provider Name (Legal Business Name): SOFIA SELIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S 29TH ST STE 1
FORT DODGE IA
50501-5503
US

IV. Provider business mailing address

503 LAURI LN
CHEROKEE IA
51012-1123
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-9376
  • Fax:
Mailing address:
  • Phone: 712-221-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number127936
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: