Provider Demographics
NPI:1295031805
Name:PIETSCH, STACY D (MA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:PIETSCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 N 3RD ST STE 418
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2730
Mailing Address - Country:US
Mailing Address - Phone:509-952-7606
Mailing Address - Fax:509-457-4485
Practice Address - Street 1:32 N 3RD ST STE 418
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2730
Practice Address - Country:US
Practice Address - Phone:509-952-7606
Practice Address - Fax:509-457-4485
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60163944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health