MEDICARE: CHELSAE SIEBENALER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1023417904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSAE SIEBENALER

Provider Business Mailing Address
First Line	:	928 W MARKET ST
Second Line	:	SUITE A
City	:	TIFFIN
State	:	OH
Zip	:	44883-2529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 W MARKET ST
Second Line	:	SUITE A
City	:	TIFFIN
State	:	OH
Zip	:	44883-2529
Country	:	US
Telephone Number	:	419-447-2927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	08/18/2014

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Directions to “ CHELSAE SIEBENALER ” Practice Location

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