Provider Demographics
NPI:1720809817
Name:TRAYLOR, CIERA ELIZABETH (LSW)
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:ELIZABETH
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CIERA
Other - Middle Name:ELIZABETH
Other - Last Name:TRAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3903 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2555
Mailing Address - Country:US
Mailing Address - Phone:219-769-4005
Mailing Address - Fax:219-392-6998
Practice Address - Street 1:3903 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2555
Practice Address - Country:US
Practice Address - Phone:219-392-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012373A104100000X
IL150113546104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker