Healthcare Provider Details

I. General information

NPI: 1770236671
Provider Name (Legal Business Name): ERICA ANNE PEDERSEN MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 MURRIETA HOT SPRINGS RD STE F120
MURRIETA CA
92563-9121
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-1600
  • Fax:
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: