MEDICARE: KELSEY NICOLE SIEGEL MSW, CAPSW

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	128091-121	WI

General Provider Information

NPI Number	:	1609165901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY NICOLE SIEGEL MSW, CAPSW

Provider Business Mailing Address
First Line	:	6333 ODANA RD
Second Line	:	SUITE 20, ORION FAMILY SERVICES
City	:	MADISON
State	:	WA
Zip	:	53719
Country	:	US
Telephone Number	:	608-270-2511
Fax Number	:	608-270-0467

Provider Business Practice Location Address
First Line	:	1201 TOMPKINS DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53716-3272
Country	:	US
Telephone Number	:	608-333-9190
Fax Number	:	608-826-8024

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

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	11/29/2018

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