Basic Information
| Provider Information | |||||||||
| NPI: | 1932688983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIEVERT | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1785 W STADIUM BLVD STE 203C | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481035291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349131093 | ||||||||
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| Address1: | 1785 W STADIUM BLVD STE 203C | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481035291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349131093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2018 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301009228 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.