Provider Demographics
NPI:1588614499
Name:SIERS, LATINA ELSE (PHD, LP)
Entity Type:Individual
Prefix:MS
First Name:LATINA
Middle Name:ELSE
Last Name:SIERS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 MILLER TRUNK HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4448
Mailing Address - Country:US
Mailing Address - Phone:218-524-8889
Mailing Address - Fax:218-524-8890
Practice Address - Street 1:1702 MILLER TRUNK HWY STE 209
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4448
Practice Address - Country:US
Practice Address - Phone:218-524-8889
Practice Address - Fax:218-524-8890
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3562101Y00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN327376800Medicaid
MN680001038Medicare ID - Type Unspecified