Provider Demographics
NPI:1386348670
Name:HILDEBRAND, CIERRA TAYLOR
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:TAYLOR
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:TAYLOR
Other - Last Name:HILDEBRAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1715 E MAIN APT AA308
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6793
Mailing Address - Country:US
Mailing Address - Phone:385-255-0574
Mailing Address - Fax:
Practice Address - Street 1:325 W GOWE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5892
Practice Address - Country:US
Practice Address - Phone:253-833-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CG61423834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health