Individual
MRS. PAMELA MAE PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
722 S LINCOLN AVE, SUITE 1, YORK, NE 68467-4216
(402) 362-6128
(402) 362-7012
Mailing address
71 KUESTER LAKE, GRAND ISLAND, NE 68801
(308) 382-5356
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
326
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47052851509
—
NE
05
—
47052851517
—
NE
05
—
47052851582
—
NE
01
—
85276
BCBS
—
Enumeration date
10/16/2006
Last updated
08/20/2007
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