Healthcare Provider Details

I. General information

NPI: 1508472358
Provider Name (Legal Business Name): LORELEI OLIVIA SIEMASZ LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30903 W 10 MILE RD
FARMINGTON HILLS MI
48336-2615
US

IV. Provider business mailing address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

V. Phone/Fax

Practice location:
  • Phone: 517-580-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851122371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: