Provider Demographics
NPI:1568992006
Name:PIERCE, LINDA SUE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24436 ARMADA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005
Mailing Address - Country:US
Mailing Address - Phone:586-784-8237
Mailing Address - Fax:586-784-8237
Practice Address - Street 1:24436 ARMADA RIDGE RD
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005
Practice Address - Country:US
Practice Address - Phone:586-784-8237
Practice Address - Fax:586-784-8237
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF500066456320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities