| NPI | 1598175440 |
|---|---|
| Former Name | HEIDI MARIE PEDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006146) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2022-08-19 |