MEDICARE: MICHELLE RENEE SIERSCHULA CDCA PRELIMINARY

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.192691	OH

General Provider Information

NPI Number	:	1285427872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE SIERSCHULA CDCA PRELIMINARY

Provider Business Mailing Address
First Line	:	4940 CHAMBERSBURG RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-3619
Country	:	US
Telephone Number	:	440-249-6288
Fax Number	:	937-310-1199

Provider Business Practice Location Address
First Line	:	1725 E 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1850
Country	:	US
Telephone Number	:	440-249-6288
Fax Number	:	937-310-1199

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

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	12/04/2025

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