Provider Demographics
NPI:1538264445
Name:SIEREN, LEA (LISW)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:SIEREN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6416
Mailing Address - Country:US
Mailing Address - Phone:641-684-7744
Mailing Address - Fax:
Practice Address - Street 1:1112 N VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6416
Practice Address - Country:US
Practice Address - Phone:641-684-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00831101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11698OtherINDIVIDUAL PROVIDER #
IA43609OtherINDIVIDUAL PROVIDER #
IA421525352-02OtherINDIVIDUAL PROVIDER #
IA2776088Medicaid
IA260048928OtherINDIIDUAL PROVIDER #
IA11698OtherINDIVIDUAL PROVIDER #