Kathryn Marie Pedgrift, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

24991 Issued in CA

Practice address

10065 Old Grove Rd Ste 200
San Diego, CA 92131-1664

Phone

(858) 444-8823

Fax

(858) 444-8827

NPI assigned

Jan 30, 2007

Last updated

Jun 5, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338854400000",
    "number": "1578609822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 FIFTH AVE APT 2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034238",
            "telephone_number": "415-710-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10065 OLD GROVE RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311664",
            "telephone_number": "858-444-8823",
            "fax_number": "858-444-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDGRIFT",
        "first_name": "KATHRYN",
        "middle_name": "MARIE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2012-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "24991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aron Pederson
• Carol Pederson, LCSW
• Heather Elizabeth Pederson, LMFT
• Julia Pederson, DNP
• Thomas Gregg Pederson, MD
• Pediatric Cardiology of San Diego
• Pediatric Neurology Therapeutics
• Pediatric Office Anesthesia Specialists
• Pediatric Orthopedic and Scoliosis Center of San Diego, Inc.
• Pediatric Primary Care Associated Medical Group

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.