Basic Information
| Provider Information | |||||||||
| NPI: | 1104114248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIECK | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | JEX | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024743322 | ||||||||
| FaxNumber: | 4024744668 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024743322 | ||||||||
| FaxNumber: | 4024744668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2011 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4223 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 1229 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 1494 | NE | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.