Provider Demographics
NPI:1659550580
Name:THE SIERRA SPEECH & LANGUAGE GROUP
Entity Type:Organization
Organization Name:THE SIERRA SPEECH & LANGUAGE GROUP
Other - Org Name:THE SIERRA SPEECH & LANGUAGE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:775-852-6323
Mailing Address - Street 1:155 COUNTRY ESTATES CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4005
Mailing Address - Country:US
Mailing Address - Phone:775-852-6323
Mailing Address - Fax:775-852-6321
Practice Address - Street 1:155 COUNTRY ESTATES CIR
Practice Address - Street 2:STE 200
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4005
Practice Address - Country:US
Practice Address - Phone:775-852-6323
Practice Address - Fax:775-852-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV946, 893, 958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505969Medicaid
NV100506124Medicaid