Provider Demographics
NPI:1184780132
Name:PIERSON, BARBARA E (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:PIERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 GAMBLE DR
Mailing Address - Street 2:STE 395
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1510
Mailing Address - Country:US
Mailing Address - Phone:612-532-2723
Mailing Address - Fax:844-825-0145
Practice Address - Street 1:5353 GAMBLE DR
Practice Address - Street 2:STE 395
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1510
Practice Address - Country:US
Practice Address - Phone:612-532-2723
Practice Address - Fax:844-825-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN139851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN397150300Medicaid
MN397150300Medicaid