Provider Demographics
NPI:1396115341
Name:PEDIGO, JAMIE WENDELL I (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:WENDELL
Last Name:PEDIGO
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JAMIE
Other - Middle Name:WENDELL
Other - Last Name:PEDIGO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2202 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7405
Practice Address - Country:US
Practice Address - Phone:785-823-6322
Practice Address - Fax:785-823-3109
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004630780001Medicaid