Provider Demographics
NPI:1871974949
Name:PEDERSON, ALLAN
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:PEDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 KIRKPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9745
Mailing Address - Country:US
Mailing Address - Phone:803-673-2076
Mailing Address - Fax:
Practice Address - Street 1:400 KIRKPATRICK RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9745
Practice Address - Country:US
Practice Address - Phone:803-673-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor