Provider Demographics
NPI:1730483975
Name:PIERCE-WALSH, JAKE DARREN (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:DARREN
Last Name:PIERCE-WALSH
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:DARREN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:302 W SUPERIOR ST
Mailing Address - Street 2:STE 508
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-5115
Mailing Address - Country:US
Mailing Address - Phone:218-249-7000
Mailing Address - Fax:
Practice Address - Street 1:220 N 6TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1952
Practice Address - Country:US
Practice Address - Phone:218-249-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN195861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical