Provider Demographics
NPI:1659641751
Name:PIERCE, WADE STEWART (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:STEWART
Last Name:PIERCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1944
Mailing Address - Country:US
Mailing Address - Phone:801-660-5557
Mailing Address - Fax:801-734-8433
Practice Address - Street 1:31 W CENTER ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1944
Practice Address - Country:US
Practice Address - Phone:801-660-5557
Practice Address - Fax:801-734-8433
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131920-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical