Provider Demographics
NPI:1497912190
Name:PEDERSEN, JENNY ANN (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ANN
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142001
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84114-2001
Mailing Address - Country:US
Mailing Address - Phone:801-538-9103
Mailing Address - Fax:801-538-6591
Practice Address - Street 1:44 N. MARIO CAPECCHI DR.
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84114
Practice Address - Country:US
Practice Address - Phone:801-584-8215
Practice Address - Fax:801-584-8492
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6968867-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist