Individual
CIERRA SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1205 W LANE RD, MACHESNEY PARK, IL 61115-1625
(815) 469-1500
Mailing address
1205 W LANE RD, MACHESNEY PARK, IL 61115-1625
(815) 469-1500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178019989
IL
101YM0800X
Mental Health Counselor
Primary
180.017887
IL
Other
Enumeration date
08/18/2022
Last updated
01/23/2026
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