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General NPI Number Information
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NPI Number | 1902826266
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Entity Type | Individual
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Provider Name | REBECCA ANN PEDERSEN LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 1608 SUNRISE AVE STE 5
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-872-2861
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Fax | 209-578-1773
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Provider Business Mailing Address
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Address Line | 1608 SUNRISE AVE STE 5
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City | MODESTO
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State | CA
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Zip | 95350-4678
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Country | US
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Telephone | 209-872-2861
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT39055
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License Number State | CA
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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 | MFC39055
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License Number State | CA
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