Provider Demographics
NPI:1720224355
Name:PIERCE, KIERNAN C (CCC-SLP, OM)
Entity Type:Individual
Prefix:MRS
First Name:KIERNAN
Middle Name:C
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CCC-SLP, OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 KULP RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9412
Mailing Address - Country:US
Mailing Address - Phone:716-992-9299
Mailing Address - Fax:
Practice Address - Street 1:2962 KULP RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9412
Practice Address - Country:US
Practice Address - Phone:716-992-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015846-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist