Provider Demographics
NPI:1215391446
Name:PEDERSEN, KATE A (LCSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:A
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3652
Mailing Address - Country:US
Mailing Address - Phone:317-762-5283
Mailing Address - Fax:
Practice Address - Street 1:1400 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2305
Practice Address - Country:US
Practice Address - Phone:317-252-5518
Practice Address - Fax:317-261-3375
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007518A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical