Provider Demographics
NPI:1326690579
Name:LIOTTA, SIERRA ANN HAVRILLA (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:ANN HAVRILLA
Last Name:LIOTTA
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SOUTHERN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9706
Mailing Address - Country:US
Mailing Address - Phone:706-466-2865
Mailing Address - Fax:
Practice Address - Street 1:225 SOUTHERN CREEK CIR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9706
Practice Address - Country:US
Practice Address - Phone:706-466-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
-OtherN/A