MEDICARE: SIERRA DULLEA WEIR M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	24980	CA

General Provider Information

NPI Number	:	1144598970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA DULLEA WEIR M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3135 SACRAMENTO STREET
Second Line	:	3
City	:	BERKELEY
State	:	CA
Zip	:	94702-1120
Country	:	US
Telephone Number	:	510-610-4610
Fax Number	:	415-358-7457

Provider Business Practice Location Address
First Line	:	3220 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2726
Country	:	US
Telephone Number	:	510-766-0132
Fax Number	:	415-358-7457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	01/18/2019

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