Provider Demographics
NPI:1659562817
Name:SIERAKOWSKI, RITA MAE (MA LLP)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:MAE
Last Name:SIERAKOWSKI
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6110
Mailing Address - Country:US
Mailing Address - Phone:989-686-1990
Mailing Address - Fax:989-686-0474
Practice Address - Street 1:1420 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6110
Practice Address - Country:US
Practice Address - Phone:989-686-1990
Practice Address - Fax:989-686-0474
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist