Provider Demographics
NPI:1336796598
Name:DIMBERG, SIERRA KELSEY
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:KELSEY
Last Name:DIMBERG
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:BANNER SPORTS MEDICINE CLINIC- SCOTTSDALE
Mailing Address - Street 2:7400 N. DOBSON RD.
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BANNER SPORTS MEDICINE CLINIC-SCOTTSDALE
Practice Address - Street 2:7400 N. DOBSON RD.
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85256
Practice Address - Country:US
Practice Address - Phone:480-733-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005714103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling