Healthcare Provider Details

I. General information

NPI: 1902743503
Provider Name (Legal Business Name): SIERAH KAYE CORRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 NORTHERN DR
BURLINGTON IA
52601-2256
US

IV. Provider business mailing address

3282 175TH ST
FORT MADISON IA
52627-9766
US

V. Phone/Fax

Practice location:
  • Phone: 319-576-8028
  • Fax: 319-576-8028
Mailing address:
  • Phone: 319-576-8028
  • Fax: 319-576-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-01557
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: