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General NPI Number Information
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NPI Number | 1336860865
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Entity Type | Individual
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Provider Name | SIERRA DAWN GUNDERSON
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1446 116TH ST
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-5569
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Country | US
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Telephone | 715-239-2075
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Fax |
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Provider Business Mailing Address
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Address Line | W16092 COUNTY RD S
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City | STANLEY
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State | WI
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Zip | 54768-9302
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 700227
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License Number State | WI
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