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General NPI Number Information
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NPI Number | 1548460637
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Entity Type | Individual
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Provider Name | CONSTANCE ELDRIDGE PEDERSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3939 NE HANCOCK ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97212-5321
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Country | US
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Telephone | 503-287-4426
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Fax | 503-284-6051
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Provider Business Mailing Address
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Address Line | 10117 SE SUNNYSIDE RD # F1217
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City | CLACKAMAS
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State | OR
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Zip | 97015-7708
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Country | US
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Telephone | 503-740-1971
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Fax | 503-284-6051
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | T-24-4310
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1070
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License Number State | OR
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