Provider Demographics
NPI:1528206380
Name:PEDERSON, SUE SNYDER (MSSW LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:SNYDER
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5524 BEE CAVES ROAD
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-484-7902
Mailing Address - Fax:
Practice Address - Street 1:5524 BEE CAVES ROAD
Practice Address - Street 2:SUITE G-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-484-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical