Healthcare Provider Details

I. General information

NPI: 1144609439
Provider Name (Legal Business Name): VIVIAN THUY PEDERSON MA, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24695 PASEO DE TORONTO
YORBA LINDA CA
92887-5116
US

IV. Provider business mailing address

4701 GARDEN PL
YORBA LINDA CA
92886-3406
US

V. Phone/Fax

Practice location:
  • Phone: 714-986-7120
  • Fax:
Mailing address:
  • Phone: 714-390-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: