Provider Demographics
NPI:1033932264
Name:WIEBENSOHN, SIERRA
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:WIEBENSOHN
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 1:1444 HIGHWAY T55
Mailing Address - Street 2:
Mailing Address - City:GLADBROOK
Mailing Address - State:IA
Mailing Address - Zip Code:50635-9447
Mailing Address - Country:US
Mailing Address - Phone:563-880-5991
Mailing Address - Fax:
Practice Address - Street 1:55 UNITYPOINT WAY STE 70
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4749
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist