MEDICARE: MR. DALE WILLIAM SIEBEN LCSW

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	1041C0700X	Clinical Social Worker	2002000242	MO

General Provider Information

NPI Number	:	1235208158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE WILLIAM SIEBEN LCSW

Provider Business Mailing Address
First Line	:	6014 APPLE VALLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-2704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6014 APPLE VALLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-2704
Country	:	US
Telephone Number	:	314-745-2742
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	06/25/2026

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