Provider Demographics
NPI:1083006589
Name:PEDERSON, KARA JEANE (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:JEANE
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:JEANE
Other - Last Name:KUCHENBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:3535 40TH AVE NW STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1768
Mailing Address - Country:US
Mailing Address - Phone:507-516-0227
Mailing Address - Fax:
Practice Address - Street 1:3535 40TH AVE NW STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1768
Practice Address - Country:US
Practice Address - Phone:507-516-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical