Individual
ANITA M SIREVAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-5900
Mailing address
3302 BLUEBIRD LN, GRANITE CITY, IL 62040-5200
(618) 219-2196
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.011071
IL
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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