Provider Demographics
NPI:1023291366
Name:RIERSON, SONDRA LEIGH (AUD)
Entity type:Individual
Prefix:DR
First Name:SONDRA
Middle Name:LEIGH
Last Name:RIERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2320
Mailing Address - Country:US
Mailing Address - Phone:712-775-2625
Mailing Address - Fax:712-775-2628
Practice Address - Street 1:409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2320
Practice Address - Country:US
Practice Address - Phone:712-775-2625
Practice Address - Fax:712-775-2628
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA237600000X, 237700000X
IA000719231H00000X
IA719231H00000X, 237600000X
IA982237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1797004OtherMEDICARE
IAIB1795004OtherMEDICARE
IAIB1798004OtherMEDICARE
IAIB1796004OtherMEDICARE
IAIB1704004OtherMEDICARE
IAIB1799004OtherMEDICARE