Provider Demographics
NPI:1801397070
Name:LONT, SIERRA SAVANAH
Entity Type:Individual
Prefix:MS
First Name:SIERRA
Middle Name:SAVANAH
Last Name:LONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 88TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3031
Mailing Address - Country:US
Mailing Address - Phone:360-301-5367
Mailing Address - Fax:
Practice Address - Street 1:20903 70TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7201
Practice Address - Country:US
Practice Address - Phone:425-672-3333
Practice Address - Fax:425-712-0539
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA486099133Medicaid