Healthcare Provider Details

I. General information

NPI: 1407279839
Provider Name (Legal Business Name): HEATHER SIEK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 37TH AVE S
MOORHEAD MN
56560-5524
US

IV. Provider business mailing address

1201 25TH ST S PO BOX 9859
FARGO ND
58103-2311
US

V. Phone/Fax

Practice location:
  • Phone: 701-451-4811
  • Fax: 651-925-0057
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1140
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: