Provider Demographics
NPI:1811980063
Name:HEDEGARD, V CHRISTIAN (MA)
Entity type:Individual
Prefix:MR
First Name:V
Middle Name:CHRISTIAN
Last Name:HEDEGARD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CEDAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-8707
Mailing Address - Country:US
Mailing Address - Phone:610-468-4331
Mailing Address - Fax:
Practice Address - Street 1:2201 RIDGEWOOD RD STE 400
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1193
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:610-378-9061
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006263-L103T00000X, 103TB0200X, 103TH0004X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS-006263-LOtherLICENSED PSYCHOLOGIST
PA1009647800007Medicaid
11260858OtherCAQH