Provider Demographics
NPI:1295369148
Name:PEDIGO, RANDI
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 N 155TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6002
Mailing Address - Country:US
Mailing Address - Phone:206-856-2776
Mailing Address - Fax:
Practice Address - Street 1:1516 N 155TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6002
Practice Address - Country:US
Practice Address - Phone:206-856-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health