MEDICARE: SIERRA ELIZABETH SEIDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-77414	MO

General Provider Information

NPI Number	:	1285450395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA ELIZABETH SEIDEL

Provider Business Mailing Address
First Line	:	3320 WHITE PINE DR
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-3002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 WHITE PINE DR
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-3002
Country	:	US
Telephone Number	:	314-717-6599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2024
Last Update Date	:	11/23/2024

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Directions to “ SIERRA ELIZABETH SEIDEL ” Practice Location

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