Healthcare Provider Details

I. General information

NPI: 1285486191
Provider Name (Legal Business Name): SIERRA GLENNON-LEVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 UNION AVE
BOULDER CO
80304-0709
US

IV. Provider business mailing address

4845 PEARL EAST CIRCLE STE 118 #186304
BOULDER CO
80301-6112
US

V. Phone/Fax

Practice location:
  • Phone: 610-945-7590
  • Fax:
Mailing address:
  • Phone: 610-945-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933354
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: