Provider Demographics
NPI:1063765469
Name:SIEVERT, ROD A
Entity type:Individual
Prefix:MR
First Name:ROD
Middle Name:A
Last Name:SIEVERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 GATEPOST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1586
Mailing Address - Country:US
Mailing Address - Phone:702-633-7975
Mailing Address - Fax:702-989-0738
Practice Address - Street 1:1616 GATEPOST AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1586
Practice Address - Country:US
Practice Address - Phone:702-633-7975
Practice Address - Fax:702-989-0738
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst