Provider Demographics
NPI:1528737731
Name:PEDERSEN, ALISE CHRISTINE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ALISE
Middle Name:CHRISTINE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WATKINS LN UNIT 205
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9276
Mailing Address - Country:US
Mailing Address - Phone:630-770-3104
Mailing Address - Fax:
Practice Address - Street 1:900 E DIEHL RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2394
Practice Address - Country:US
Practice Address - Phone:630-328-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105393104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker