Healthcare Provider Details

I. General information

NPI: 1053059428
Provider Name (Legal Business Name): SIERRA HIGHTOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY PORTER HALL ROOM 002
ATHENS OH
45701
US

IV. Provider business mailing address

1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY PORTER HALL ROOM 002
ATHENS OH
45701
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-0902
  • Fax: 740-593-4790
Mailing address:
  • Phone: 740-593-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: