Healthcare Provider Details

I. General information

NPI: 1609796630
Provider Name (Legal Business Name): CIERRA LEFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST STE C
PAW PAW MI
49079-2008
US

IV. Provider business mailing address

155 WALNUT ST
COLOMA MI
49038-9503
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-5574
  • Fax:
Mailing address:
  • Phone: 269-930-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852094694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: