Provider Demographics
NPI:1851941710
Name:HEATON, SIERA MICHELLE
Entity Type:Individual
Prefix:
First Name:SIERA
Middle Name:MICHELLE
Last Name:HEATON
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 1:195 N 290 W
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5001
Mailing Address - Country:US
Mailing Address - Phone:801-785-4749
Mailing Address - Fax:
Practice Address - Street 1:195 N 290 W
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5001
Practice Address - Country:US
Practice Address - Phone:801-785-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist