Provider Demographics
NPI:1316209042
Name:PIERCE, JACQUELINE LOUISE (TEACHER MSED)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LOUISE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:TEACHER MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114-75 178TH PLACE
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1409
Mailing Address - Country:US
Mailing Address - Phone:917-699-6298
Mailing Address - Fax:718-298-9632
Practice Address - Street 1:11475 178TH PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1409
Practice Address - Country:US
Practice Address - Phone:718-298-9630
Practice Address - Fax:718-298-9632
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist