Basic Information
| Provider Information | |||||||||
| NPI: | 1295984896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERE | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | MAY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WALTMAN | ||||||||
| OtherFirstName: | STACY | ||||||||
| OtherMiddleName: | MAY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW, LICSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9120 SPRINGBROOK DR NW | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554335845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1267677222 | ||||||||
| FaxNumber: | 1268616050 | ||||||||
| Practice Location | |||||||||
| Address1: | 9120 SPRINGBROOK DR NW | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554335845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6372312590 | ||||||||
| FaxNumber: | 6128616050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 22493 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.