Healthcare Provider Details

I. General information

NPI: 1720778624
Provider Name (Legal Business Name): ASHLEY SIEBRASSE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DAHL RD STE 8
SPEARFISH SD
57783-2739
US

IV. Provider business mailing address

611 DAHL RD STE 8
SPEARFISH SD
57783-2739
US

V. Phone/Fax

Practice location:
  • Phone: 605-546-6840
  • Fax: 605-546-6841
Mailing address:
  • Phone: 605-546-6840
  • Fax: 605-546-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH30976
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: