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General NPI Number Information
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NPI Number | 1215806609
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Entity Type | Individual
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Provider Name | HOLLY PEDERSEN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1301 W 5TH ST
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City | CROFTON
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State | NE
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Zip | 68730-4120
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Country | US
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Telephone | 402-388-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 211 10TH ST
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City | WAKEFIELD
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State | NE
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Zip | 68784-5014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 9681404483
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License Number State | NE
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