MEDICARE: MS. PHYLLIS K. SIEBERT LCPC, CADC

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	25239	IL
2	101YP2500X	Professional Counselor	180.008148	IL

General Provider Information

NPI Number	:	1306185988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS K. SIEBERT LCPC, CADC

Provider Business Mailing Address
First Line	:	1240 BAMBURG CT
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-5243
Country	:	US
Telephone Number	:	630-372-6599
Fax Number	:	630-372-6697

Provider Business Practice Location Address
First Line	:	1240 BAMBURG CT
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-5243
Country	:	US
Telephone Number	:	630-372-6599
Fax Number	:	630-372-6697

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

Provider Enumeration Date	:	02/02/2013
Last Update Date	:	02/02/2013

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