Healthcare Provider Details

I. General information

NPI: 1932224094
Provider Name (Legal Business Name): PATRICIA A PIERCE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 MAIN ST
SAINT JOSEPH MI
49085-1426
US

IV. Provider business mailing address

PO BOX 679
SAINT JOSEPH MI
49085-0679
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-2000
  • Fax: 269-985-2002
Mailing address:
  • Phone: 269-985-2000
  • Fax: 269-985-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801071984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: