Provider Demographics
NPI:1407427586
Name:WEBER, SIERRA NICHOLE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICHOLE
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 COUNTRYSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-5822
Mailing Address - Country:US
Mailing Address - Phone:210-884-3338
Mailing Address - Fax:
Practice Address - Street 1:252 COUNTRYSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-5822
Practice Address - Country:US
Practice Address - Phone:210-884-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-21-48900103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst