Healthcare Provider Details

I. General information

NPI: 1285489260
Provider Name (Legal Business Name): SIERRA MARIE OVERTON THOMPSON M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 BONITA VISTA DR
SANTA ROSA CA
95404
US

IV. Provider business mailing address

1548 MONARCH PL
ROHNERT PARK CA
94928-3602
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-3925
  • Fax:
Mailing address:
  • Phone: 707-490-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: