Provider Demographics
NPI:1922722479
Name:VIERRA, STACIA ANN (LSWAIC)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:ANN
Last Name:VIERRA
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19002 92ND AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6161
Mailing Address - Country:US
Mailing Address - Phone:253-414-2844
Mailing Address - Fax:
Practice Address - Street 1:19002 92ND AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6161
Practice Address - Country:US
Practice Address - Phone:253-414-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC613288451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical