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General NPI Number Information
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NPI Number | 1801374160
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Entity Type | Individual
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Provider Name | ALLYSSA RE'ANNE SIEGRIST
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Gender | Female
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 1431 AIRPORT LN
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City | NORTH BEND
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State | OR
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Zip | 97459-2008
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Country | US
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Telephone | 545-464-6455
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Fax |
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Provider Business Mailing Address
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Address Line | 379 6TH AVE
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City | COOS BAY
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State | OR
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Zip | 97420-4379
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Country | US
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Telephone | 541-294-9354
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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