Healthcare Provider Details

I. General information

NPI: 1821923079
Provider Name (Legal Business Name): KATIE SIEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 CEDAR CT
DIXON IL
61021-9053
US

IV. Provider business mailing address

891 CEDAR CT
DIXON IL
61021-9053
US

V. Phone/Fax

Practice location:
  • Phone: 312-550-2539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number367676
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: