Healthcare Provider Details

I. General information

NPI: 1063251593
Provider Name (Legal Business Name): SIERRA DAWN BETTS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55505 NATIONAL RD
BRIDGEPORT OH
43912-1538
US

IV. Provider business mailing address

41562 BROWN RD
BETHESDA OH
43719-9794
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9773
  • Fax:
Mailing address:
  • Phone: 740-213-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: