Healthcare Provider Details

I. General information

NPI: 1609527662
Provider Name (Legal Business Name): AUBREY E SIEBERG PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MARSHALL ST
SAINT PETER MN
56082-4500
US

IV. Provider business mailing address

1306 MARSHALL ST
SAINT PETER MN
56082-4500
US

V. Phone/Fax

Practice location:
  • Phone: 507-931-8040
  • Fax: 507-931-8060
Mailing address:
  • Phone: 507-931-8040
  • Fax: 507-931-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6750
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP6750
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6750
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: