Provider Demographics
NPI:1093204893
Name:BERTSCH, CIERRA LIN (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:CIERRA
Middle Name:LIN
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 QUAIL LAKES DR # G240
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:209-952-2588
Mailing Address - Fax:
Practice Address - Street 1:3031 W MARCH LN STE 117
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6568
Practice Address - Country:US
Practice Address - Phone:209-952-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant