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General NPI Number Information
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NPI Number | 1801775333
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Entity Type | Individual
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Provider Name | LISA PEDERSON SLPA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 418 E VANDERBILT WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3552
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Country | US
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Telephone | 909-373-1641
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Fax |
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Provider Business Mailing Address
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Address Line | 10655 LEMON AVE APT 1401
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-6958
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Country | US
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Telephone | 909-519-6787
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 2096
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License Number State | CA
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