NPI | 1851800841 |
---|---|
Former Name | KIMBERLY PEDERSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35813) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS018354) |
Enumeration Date | 2017-09-22 |
Last Update Date | 2025-10-03 |