MEDICARE: ASHLEY NICOLE SIEPKA MSW

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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149.020839	OTHER	IL	PROFESSIONAL LICENSE NUMBER

General Provider Information

NPI Number	:	1356796304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE SIEPKA MSW

Provider Business Mailing Address
First Line	:	322 W BACON ST
Second Line	:
City	:	AMBOY
State	:	IL
Zip	:	61310-1045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 E LINCOLNWAY STE C
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-9740
Country	:	US
Telephone Number	:	815-626-8760
Fax Number	:

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

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/09/2026

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