Healthcare Provider Details

I. General information

NPI: 1336063874
Provider Name (Legal Business Name): ANNA M SIDERIUS SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROBOCKER LN
KALISPELL MT
59901-8292
US

IV. Provider business mailing address

1935 3RD AVE E
KALISPELL MT
59901-5780
US

V. Phone/Fax

Practice location:
  • Phone: 406-260-1626
  • Fax:
Mailing address:
  • Phone: 406-607-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-SWLC-LIC-81331
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: