Individual
SUSAN SIEWEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CO
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33000005
MEDICAID REHAB
AL
Enumeration date
08/09/2006
Last updated
07/08/2007
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