Provider Demographics
NPI:1376033373
Name:PIER, DUSTIE ROSE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DUSTIE
Middle Name:ROSE
Last Name:PIER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2707
Mailing Address - Country:US
Mailing Address - Phone:574-298-5062
Mailing Address - Fax:
Practice Address - Street 1:110 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2707
Practice Address - Country:US
Practice Address - Phone:765-481-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-16-26174106S00000X
IN1-20-44647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician