Provider Demographics
NPI:1598832958
Name:PEDERSEN, RONDA A (LSW)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:A
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PULVER HALL
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4857
Mailing Address - Country:US
Mailing Address - Phone:701-227-7536
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:200 PULVER HALL
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4857
Practice Address - Country:US
Practice Address - Phone:701-227-7536
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2286104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid
ND79293OtherSED CARE COORDINATOR