Healthcare Provider Details

I. General information

NPI: 1003308768
Provider Name (Legal Business Name): MATTHEW J SIEKKINEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 HILLSDALE AVE
GREENCASTLE IN
46135-1340
US

IV. Provider business mailing address

620 8TH AVE
TERRE HAUTE IN
47804-2771
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-1024
  • Fax:
Mailing address:
  • Phone: 812-231-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012446A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33007302A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: