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General NPI Number Information
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NPI Number | 1043938707
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Entity Type | Individual
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Provider Name | MARK SIEKIERSKI
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Gender | Male
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 201 HOUSTON ST
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City | BATAVIA
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State | IL
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Zip | 60510-1960
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Country | US
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Telephone | 847-306-5461
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Fax |
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Provider Business Mailing Address
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Address Line | 671 BLACKHAWK DR
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City | BATAVIA
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State | IL
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Zip | 60510-1198
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Country | US
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Telephone | 630-205-0444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.010728
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License Number State | IL
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