Provider Demographics
NPI:1235389099
Name:PIERCE, JODY (LCSW)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9572
Mailing Address - Country:US
Mailing Address - Phone:720-989-8546
Mailing Address - Fax:303-665-2350
Practice Address - Street 1:1017 S BOULDER RD
Practice Address - Street 2:SUITE G
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2563
Practice Address - Country:US
Practice Address - Phone:720-989-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9894681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical