Provider Demographics
NPI:1003357054
Name:PIERRE, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 MONONA DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6320 MONONA DR
Practice Address - Street 2:SUITE 415
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3952
Practice Address - Country:US
Practice Address - Phone:608-455-6070
Practice Address - Fax:608-455-6070
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78191231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical