Provider Demographics
NPI:1396293106
Name:SIERRA, NELLIE (MS)
Entity type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SW 212TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6447
Mailing Address - Country:US
Mailing Address - Phone:503-521-0158
Mailing Address - Fax:
Practice Address - Street 1:55 SW 212TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6447
Practice Address - Country:US
Practice Address - Phone:503-521-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR32237235Z00000X
WA00003288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist