Provider Demographics
NPI:1568140309
Name:ASHWORTH, SIERRA SHYANN
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:SHYANN
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:SHYANN
Other - Last Name:VINING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6093 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9514
Mailing Address - Country:US
Mailing Address - Phone:810-455-8471
Mailing Address - Fax:
Practice Address - Street 1:3710 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2160
Practice Address - Country:US
Practice Address - Phone:989-324-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician