Provider Demographics
NPI:1386022978
Name:PEDERSEN, REBECCA CONNIE (LICSW,SUDP,LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CONNIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LICSW,SUDP,LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CONNIE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:802 E BAMBERGER DR STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2179
Mailing Address - Country:US
Mailing Address - Phone:801-633-9887
Mailing Address - Fax:
Practice Address - Street 1:802 E BAMBERGER DR STE A
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2179
Practice Address - Country:US
Practice Address - Phone:801-633-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60818488101YA0400X
WALW610893311041C0700X
UT365936-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty