Provider Demographics
NPI:1144092933
Name:BURN, SIERRA JANE
Entity type:Individual
Prefix:MISS
First Name:SIERRA
Middle Name:JANE
Last Name:BURN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SIERRA
Other - Middle Name:JANE
Other - Last Name:BURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:287 SE WESTOWN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5026
Mailing Address - Country:US
Mailing Address - Phone:515-402-3933
Mailing Address - Fax:
Practice Address - Street 1:287 SE WESTOWN PARKWAY
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-417-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician