Provider Demographics
NPI:1720493679
Name:SIEBERT, RACHEL DAWN MARY
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:DAWN MARY
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MANZANA CT NW APT 1A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-5748
Mailing Address - Country:US
Mailing Address - Phone:313-213-6337
Mailing Address - Fax:
Practice Address - Street 1:162 MANZANA CT NW APT 1A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-5748
Practice Address - Country:US
Practice Address - Phone:313-213-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MI68010970441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula