Provider Demographics
NPI:1295196509
Name:PEDERSEN, SARAH GALLAGHER (SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GALLAGHER
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 DAHLK CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8845
Mailing Address - Country:US
Mailing Address - Phone:608-845-7878
Mailing Address - Fax:
Practice Address - Street 1:2269 DAHLK CIR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8845
Practice Address - Country:US
Practice Address - Phone:608-845-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist