Provider Demographics
NPI:1750391678
Name:PEDERSON, JILL ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:PEDERSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 S HARBOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7936
Mailing Address - Country:US
Mailing Address - Phone:949-569-0182
Mailing Address - Fax:
Practice Address - Street 1:3631 S HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7936
Practice Address - Country:US
Practice Address - Phone:949-569-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 206221041C0700X
WI7280-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical