Provider Demographics
NPI:1356846117
Name:PEDERSEN, ROSA (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WEST AVE W
Mailing Address - Street 2:
Mailing Address - City:DUNDAS
Mailing Address - State:MN
Mailing Address - Zip Code:55019-3918
Mailing Address - Country:US
Mailing Address - Phone:507-581-4219
Mailing Address - Fax:
Practice Address - Street 1:301 WEST AVE W
Practice Address - Street 2:
Practice Address - City:DUNDAS
Practice Address - State:MN
Practice Address - Zip Code:55019-3918
Practice Address - Country:US
Practice Address - Phone:507-581-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MNCC03718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician