Provider Demographics
NPI:1962286542
Name:SIELOFF, ANDREA MARIE (LPC-IT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:SIELOFF
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2815
Mailing Address - Country:US
Mailing Address - Phone:920-615-6535
Mailing Address - Fax:
Practice Address - Street 1:1401 NELSON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2815
Practice Address - Country:US
Practice Address - Phone:920-615-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7586-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health