Healthcare Provider Details

I. General information

NPI: 1821740770
Provider Name (Legal Business Name): SIERRA JO MARIE MOHR LMSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 5TH ST STE 100
SIOUX CITY IA
51101-1510
US

IV. Provider business mailing address

25 3RD AVE SW
LE MARS IA
51031-3449
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-2007
  • Fax: 712-277-2189
Mailing address:
  • Phone: 712-541-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21099
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113535
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: