Healthcare Provider Details

I. General information

NPI: 1063641041
Provider Name (Legal Business Name): SIERRA L SWING PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 SW ALASKA ST
SEATTLE WA
98126-2730
US

IV. Provider business mailing address

3515 SW ALASKA ST
SEATTLE WA
98126-2730
US

V. Phone/Fax

Practice location:
  • Phone: 206-979-8787
  • Fax: 206-309-3373
Mailing address:
  • Phone: 206-979-8787
  • Fax: 206-309-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60039110
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY60039110
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY60039110
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60039110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: