Healthcare Provider Details

I. General information

NPI: 1215673843
Provider Name (Legal Business Name): DRYDEN NICHOLAS PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 N RIVER RD
FREELAND MI
48623-8856
US

IV. Provider business mailing address

3949 N RIVER RD
FREELAND MI
48623-8856
US

V. Phone/Fax

Practice location:
  • Phone: 989-702-2082
  • Fax:
Mailing address:
  • Phone: 989-702-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7402000283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: