Provider Demographics
NPI:1043051717
Name:SMITH, SIERRA H (APSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 S GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3325
Mailing Address - Country:US
Mailing Address - Phone:715-302-2805
Mailing Address - Fax:
Practice Address - Street 1:227400 RIB MOUNTAIN DR STE D
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5049
Practice Address - Country:US
Practice Address - Phone:715-302-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134905-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker