Provider Demographics
NPI:1447035332
Name:PIERPONT, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PIERPONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S UNION ST UNIT 508
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3985
Mailing Address - Country:US
Mailing Address - Phone:401-829-7355
Mailing Address - Fax:
Practice Address - Street 1:150 FULLER AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1922
Practice Address - Country:US
Practice Address - Phone:401-829-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist