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General NPI Number Information
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NPI Number | 1427129923
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Entity Type | Individual
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Provider Name | LAILA PEDERSEN FINGERHUT LCSW LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 17917 KILLINGTON WAY
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City | SOUTH BEND
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State | IN
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Zip | 46614-9773
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Country | US
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Telephone | 574-291-2645
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Fax | 574-291-3700
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Provider Business Mailing Address
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Address Line | 17917 KILLINGTON DR
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City | SOUTH BEND
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State | IN
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Zip | 46614-9773
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Country | US
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Telephone | 574-291-2645
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Fax | 574-291-3700
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34002895A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001428A
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License Number State | IN
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