Individual
DR. DIXIE J PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2 N 19TH ST, LAFAYETTE, IN 47904-2950
(765) 491-0002
Mailing address
2 N 19TH ST, LAFAYETTE, IN 47904-2950
(765) 491-0002
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
HSPP20010440
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HSPP20010440
STATE BOARD OF EXAMINERS
IN
Enumeration date
08/07/2007
Last updated
08/07/2007
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