Provider Demographics
NPI:1669020988
Name:KAMPLAIN, SIERRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:KAMPLAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S OLIVE ST APT 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4172
Mailing Address - Country:US
Mailing Address - Phone:406-600-7017
Mailing Address - Fax:
Practice Address - Street 1:5800 S EASTERN AVE STE 500
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4033
Practice Address - Country:US
Practice Address - Phone:562-442-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31214235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty