MEDICARE: HEATHER LEE SEIBEL LSW

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	4875	ND

General Provider Information

NPI Number	:	1720415326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LEE SEIBEL LSW

Provider Business Mailing Address
First Line	:	415 E ROSSER AVE
Second Line	:	STE 113
City	:	BISMARCK
State	:	ND
Zip	:	58501-4058
Country	:	US
Telephone Number	:	701-222-6622
Fax Number	:	701-222-6644

Provider Business Practice Location Address
First Line	:	415 E ROSSER AVE
Second Line	:	STE 113
City	:	BISMARCK
State	:	ND
Zip	:	58501-4058
Country	:	US
Telephone Number	:	701-222-6622
Fax Number	:	701-222-6644

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	07/31/2014

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Directions to “ HEATHER LEE SEIBEL LSW” Practice Location

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