Provider Demographics
NPI:1053073890
Name:PIERICK, MARY (MSED)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PIERICK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5124
Mailing Address - Country:US
Mailing Address - Phone:651-300-9273
Mailing Address - Fax:
Practice Address - Street 1:3910 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-5124
Practice Address - Country:US
Practice Address - Phone:651-300-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician