Provider Demographics
NPI:1619315900
Name:PIERCE, JENNA (MS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22930 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9148
Mailing Address - Country:US
Mailing Address - Phone:480-254-3679
Mailing Address - Fax:
Practice Address - Street 1:6067 BRISTOL PARKWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:310-642-7700
Practice Address - Fax:310-645-0394
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist