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Individual

MRS. LAILA PEDERSEN FINGERHUT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW LMFT

Contact information

Practice address
17917 KILLINGTON WAY, SOUTH BEND, IN 46614-9773
(574) 291-2645
(574) 291-3700
Mailing address
17917 KILLINGTON DR, SOUTH BEND, IN 46614-9773
(574) 291-2645
(574) 291-3700

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002895A
IN
106H00000X
Marriage & Family Therapist
35001428A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100113330
IN
01
11627900
CAQH
IN
Enumeration date
11/13/2006
Last updated
01/20/2011
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