Individual
MRS. AMY BETH PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
7006 GREENWOOD CT, ROCKFORD, MN 55373-4581
(612) 961-8310
Mailing address
PO BOX 266, ROCKFORD, MN 55373-0266
(612) 961-8310
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7434
MN
235Z00000X
Speech-Language Pathologist
FILE FOLDER # 389213
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146T2PE
BCBS PARTICIPAT. PROVID.#
MN
01
—
4601172
MEDICA PROVIDER NUMBER
—
01
—
5727164
MINNESOTA TAX ID #
MN
Enumeration date
03/08/2007
Last updated
04/01/2009
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