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Individual

MS. JO ANNE PEDERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
201 CIRCLE DR, HARTLAND, WI 53029-1806
(262) 352-6047

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13938
WI
1041C0700X
Clinical Social Worker
Primary
6849123
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
43572000
WI
Enumeration date
11/22/2006
Last updated
10/25/2007
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