Provider Demographics
NPI:1124308457
Name:PEDERSEN, ELIZABETH JANE (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3532
Mailing Address - Country:US
Mailing Address - Phone:781-749-7966
Mailing Address - Fax:
Practice Address - Street 1:3 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3532
Practice Address - Country:US
Practice Address - Phone:781-749-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist