Provider Demographics
NPI:1013920842
Name:PIERING, PEDER NELSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEDER
Middle Name:NELSON
Last Name:PIERING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2984
Mailing Address - Country:US
Mailing Address - Phone:414-259-3900
Mailing Address - Fax:414-963-0000
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-259-3900
Practice Address - Fax:414-963-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2296-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43578200Medicaid
WI43578200Medicaid