Provider Demographics
NPI:1215944798
Name:PIERCE, MAUREEN CASANDRA (PHD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:CASANDRA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22517 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6820
Mailing Address - Country:US
Mailing Address - Phone:206-824-3950
Mailing Address - Fax:206-870-9081
Practice Address - Street 1:22517 7TH AVE S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6820
Practice Address - Country:US
Practice Address - Phone:206-824-3950
Practice Address - Fax:206-870-9081
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002983103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8852931Medicare ID - Type UnspecifiedMEDICARE