Kaejan T Pederson, MS CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Cornell, WI
NPI 1124330626 · NPPES record last updated Dec 2, 2014
Key facts
- NPI
- 1124330626
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 3382-154 (WI)
- Practice address
- 320 N 7TH St
Cornell, WI 54732-8120 - Phone
- (715) 239-0440
- Fax
- (715) 239-6608
- NPI assigned
- Jul 13, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3382-154 | WI | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3382-154 | WI | Yes |
Addresses
Primary practice location
320 N 7TH St
Cornell, WI 54732-8120
Mailing address
320 N 7TH St
Cornell, WI 54732-8120
Other providers in Cornell, WI
- Olivia Meinholz
- Kelsey Lee Meyer
- Northwoods Family Eyecare, LLC
- NSH Cornell LLC
- Katie Oliver
- Eric Gerald Phelps
- Russell Chiropractic LLC
- Jacquelyn Michele Russell
- RWG Co Inc
- Bradley Bovee Schauer
All providers in Cornell, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.