MEDICARE: MR. SIDNEY G BOERSMA 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	152227	WI
2	1041C0700X	Clinical Social Worker	2198-123	WI

General Provider Information

NPI Number	:	1992800775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIDNEY G BOERSMA LCSW

Provider Business Mailing Address
First Line	:	243 E MCKINLEY ST
Second Line	:
City	:	STOUGHTON
State	:	WI
Zip	:	53589-1626
Country	:	US
Telephone Number	:	608-873-4859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ROCK ISLAND ARSENAL
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61299-7530
Country	:	US
Telephone Number	:	309-782-4910
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/11/2025

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