Healthcare Provider Details

I. General information

NPI: 1437983681
Provider Name (Legal Business Name): SAUNDRA SUZANNE SIEBERSMA PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BLUE SKY HWY
ETHETE WY
82520
US

IV. Provider business mailing address

PO BOX 1310
RIVERTON WY
82501-0158
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-9281
  • Fax:
Mailing address:
  • Phone: 307-856-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1611
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: