Provider Demographics
NPI:1144016783
Name:PIERCE, JACKSON M (PSS)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1312
Mailing Address - Country:US
Mailing Address - Phone:415-960-7265
Mailing Address - Fax:
Practice Address - Street 1:671 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1312
Practice Address - Country:US
Practice Address - Phone:415-960-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-KYAPMF175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist