Provider Demographics
NPI:1528789294
Name:PIERSON, STEVIE M
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:M
Last Name:PIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6367
Mailing Address - Country:US
Mailing Address - Phone:208-505-9990
Mailing Address - Fax:
Practice Address - Street 1:151 N 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6367
Practice Address - Country:US
Practice Address - Phone:208-505-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator