Active NPI
Heather L Pederson, CCC-SLP
- Speech-Language Pathologist
- Buckeye, AZ
National Provider Identifier
1235346065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4778
- Practice address
- 210 S 6TH St
Buckeye, AZ 85326-2830 - Phone
- (623) 386-4487
- Fax
- (623) 386-6063
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4778 | AZ | Primary |
Addresses
Primary practice location
210 S 6TH St
Buckeye, AZ 85326-2830
Mailing address
18179 W Ocotillo Ave
Goodyear, AZ 85338-5074
Phone (602) 357-5926
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09145517 | Other | AZ | ASHA CERTIFIED MEMBER |
| 4778 | Other | AZ | SLP - REGULAR LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4778 | AZ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235346065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18179 W OCOTILLO AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853385074",
"telephone_number": "602-357-5926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S 6TH ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853262830",
"telephone_number": "623-386-4487",
"fax_number": "623-386-6063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "HEATHER",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "4778",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA CERTIFIED MEMBER",
"identifier": "09145517",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SLP - REGULAR LICENSE",
"identifier": "4778",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.