MEDICARE: DANA SIEWERTSEN

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	LCDC.141207-3	OH

General Provider Information

NPI Number	:	1457721276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA SIEWERTSEN

Provider Business Mailing Address
First Line	:	2300 WALL ST
Second Line	:	SUITE F
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2781
Country	:	US
Telephone Number	:	513-834-7063
Fax Number	:	513-429-4939

Provider Business Practice Location Address
First Line	:	2300 WALL ST
Second Line	:	SUITE F
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2781
Country	:	US
Telephone Number	:	513-834-7063
Fax Number	:	513-429-4939

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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Directions to “ DANA SIEWERTSEN ” Practice Location

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