Healthcare Provider Details

I. General information

NPI: 1295578094
Provider Name (Legal Business Name): SIERRA HOBSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 ARCHER AVE STE 12
WILLOW SPRINGS IL
60480-1294
US

IV. Provider business mailing address

39W574 N HYDE PARK
GENEVA IL
60134-4923
US

V. Phone/Fax

Practice location:
  • Phone: 708-381-0897
  • Fax:
Mailing address:
  • Phone: 630-740-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.112388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: