Healthcare Provider Details

I. General information

NPI: 1093297996
Provider Name (Legal Business Name): SIERRA CICHON MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 9TH ST STE 302
ROCKFORD IL
61104-2235
US

IV. Provider business mailing address

209 9TH ST STE 302
ROCKFORD IL
61104-2235
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-4470
  • Fax: 779-696-5858
Mailing address:
  • Phone: 779-696-4470
  • Fax: 779-696-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.015010
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.004881
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: