Provider Demographics
NPI:1083926117
Name:PEDERSEN, LAREN MICHELLE (MS BCBA)
Entity Type:Individual
Prefix:
First Name:LAREN
Middle Name:MICHELLE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FIREFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5613
Mailing Address - Country:US
Mailing Address - Phone:303-746-1561
Mailing Address - Fax:888-300-3081
Practice Address - Street 1:1033 FIREFLOWER CIR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5613
Practice Address - Country:US
Practice Address - Phone:303-746-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst