Provider Demographics
NPI:1821626185
Name:LUSSIER, CIERRA NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CIERRA
Middle Name:NICOLE
Last Name:LUSSIER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CIERRA
Other - Middle Name:NICOLE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 AUWAIOLIMU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1707
Mailing Address - Country:US
Mailing Address - Phone:808-425-1948
Mailing Address - Fax:
Practice Address - Street 1:1700 LANAKILA AVE RM 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2115
Practice Address - Country:US
Practice Address - Phone:808-832-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty