Healthcare Provider Details

I. General information

NPI: 1710632062
Provider Name (Legal Business Name): SIERRA NICOLE PRESTON-THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 RIVER RD N
SALEM OR
97303-6512
US

IV. Provider business mailing address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax: 541-246-8826
Mailing address:
  • Phone: 541-321-2278
  • Fax: 541-246-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9778
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: