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NPI Code Detail

MEDICARE: STACY MAY PIERE MSW, LICSW

MEDICARE: STACY MAY PIERE MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker22493MN

General Provider Information

NPI Number : 1295984896
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY MAY PIERE MSW, LICSW
Provider Business Mailing Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 126-767-7222
Fax Number : 126-861-6050
Provider Business Practice Location Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 637-231-2590
Fax Number : 612-861-6050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2008
Last Update Date : 03/11/2019

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