Provider Demographics
NPI:1407464282
Name:WIESE, SIERRA C (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:SIERRA
Middle Name:C
Last Name:WIESE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:SIERRA
Other - Middle Name:C
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLPA
Mailing Address - Street 1:6602 S CONSTELLATION WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-5700
Mailing Address - Country:US
Mailing Address - Phone:480-506-0016
Mailing Address - Fax:
Practice Address - Street 1:2450 E GUADALUPE RD # SUOTE109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5116
Practice Address - Country:US
Practice Address - Phone:480-506-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA125462355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant