MEDICARE: STEPHAN SIWIEC PHD

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	103TC0700X	Clinical Psychologist	3987-57	WI

General Provider Information

NPI Number	:	1487509972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN SIWIEC PHD

Provider Business Mailing Address
First Line	:	4501 BELLINGRATH ST
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8752
Country	:	US
Telephone Number	:	617-721-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	6402 ODANA RD STE 304
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1123
Country	:	US
Telephone Number	:	608-465-4565
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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