Healthcare Provider Details

I. General information

NPI: 1215806609
Provider Name (Legal Business Name): HOLLY PEDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 5TH ST
CROFTON NE
68730-4120
US

IV. Provider business mailing address

211 10TH ST
WAKEFIELD NE
68784-5014
US

V. Phone/Fax

Practice location:
  • Phone: 402-388-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9681404483
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: