Provider Demographics
NPI:1295984896
Name:PIERE, STACY MAY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MAY
Last Name:PIERE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MAY
Other - Last Name:WALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:9120 SPRINGBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5845
Mailing Address - Country:US
Mailing Address - Phone:126-767-7222
Mailing Address - Fax:126-861-6050
Practice Address - Street 1:9120 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5845
Practice Address - Country:US
Practice Address - Phone:637-231-2590
Practice Address - Fax:612-861-6050
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical