Provider Information for 1427719467
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ETHEN D SIETSEMA LPCC
Sex: Male
NPI: 1427719467
Last Updated: 2022-04-18
Certification Date: 2022-04-18
Certification Date: 2022-04-18
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1427719467 | ||||||||||||||
| Enumeration Date | 2022-01-03 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 2925 CHICAGO AVE MINNEAPOLIS, MN 55407-1321 United States Phone: 612-262-9000 | Fax: | ||||||||||||||
| Primary Practice Address | 2925 CHICAGO AVE MINNEAPOLIS, MN 55407-1321 United States Phone: 866-603-0016 | Fax: | ||||||||||||||
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