Provider Demographics
NPI:1376721902
Name:PIERCE, TODD CHRISTOPHER (PCW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 W CONCORDIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3623
Mailing Address - Country:US
Mailing Address - Phone:414-449-9877
Mailing Address - Fax:
Practice Address - Street 1:4007 W CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-449-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172V00000X172V00000X
WI177F00000X177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No177F00000XOther Service ProvidersLodging