Provider Demographics
NPI:1417007931
Name:PIERCE, HAPPY TJ (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HAPPY
Middle Name:TJ
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 BOCA NEGRA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1402
Mailing Address - Country:US
Mailing Address - Phone:505-379-9602
Mailing Address - Fax:
Practice Address - Street 1:401 N 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2507
Practice Address - Country:US
Practice Address - Phone:505-285-2614
Practice Address - Fax:505-287-8487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79135811Medicaid