# GWEN PEDERSEN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750090858
- **Authorized official:** GWEN PEDERSEN MS, LMFT (MARRIAGE & FAMILY THERAPIST)
- **Authorized official phone:** (320) 255-0343

## Contact information

- **Practice address:** 600 25TH AVE S STE 109, SAINT CLOUD, MN 56301-4820
- **Practice address phone:** (320) 260-8313
- **Practice address fax:** (320) 654-0318
- **Mailing address:** 600 25TH AVE S STE 109, SAINT CLOUD, MN 56301-4820
- **Mailing address phone:** (320) 260-8313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2022
- **Last updated:** 02/20/2024