Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 33007302A | IN |
NPI | 1003308768 |
---|---|
Provider Name | Matthew J Siekkinen |
First Address | Muncie, IN 47304-3988 |
Second Address | Muncie, IN 47303-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 30/05/2018 |