MEDICARE: KIRSTIN LEACH SIEGLER 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

General Provider Information

NPI Number	:	1447491246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTIN LEACH SIEGLER LCSW

Provider Business Mailing Address
First Line	:	2330 W ARMITAGE AVE
Second Line	:	UNIT G
City	:	CHICAGO
State	:	IL
Zip	:	60647-4359
Country	:	US
Telephone Number	:	773-910-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 W ARMITAGE AVE
Second Line	:	UNIT G
City	:	CHICAGO
State	:	IL
Zip	:	60647-4359
Country	:	US
Telephone Number	:	773-910-6622
Fax Number	:

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

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	06/28/2020

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