Provider Demographics
NPI:1699882332
Name:SEIP, MERRIE J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MERRIE
Middle Name:J
Last Name:SEIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3570
Mailing Address - Country:US
Mailing Address - Phone:309-661-8046
Mailing Address - Fax:309-661-8093
Practice Address - Street 1:103 N REGENCY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3570
Practice Address - Country:US
Practice Address - Phone:309-661-8046
Practice Address - Fax:309-661-8093
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490111661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13848Medicare ID - Type Unspecified