MEDICARE: MS. LATINA ELSE SIERS PHD, LP

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	101Y00000X	Counselor	LP3562	MN
2	103TC0700X	Clinical Psychologist	LP3562	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588614499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATINA ELSE SIERS PHD, LP

Provider Business Mailing Address
First Line	:	1702 MILLER TRUNK HWY STE 209
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-524-8889
Fax Number	:	218-524-8890

Provider Business Practice Location Address
First Line	:	1702 MILLER TRUNK HWY STE 209
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-524-8889
Fax Number	:	218-524-8890

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/29/2022

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Directions to “ MS. LATINA ELSE SIERS PHD, LP” Practice Location

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