Active NPI
Dixie J Pederson, PH.D.
- Health Service Psychologist
- Lafayette, IN
National Provider Identifier
1942491600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Psychologist
- License
- HSPP20010440
- Practice address
- 2 N 19TH St
Lafayette, IN 47904-2950 - Phone
- (765) 491-0002
- NPI assigned
- Aug 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | HSPP20010440 | IN | Primary |
Addresses
Primary practice location
2 N 19TH St
Lafayette, IN 47904-2950
Mailing address
2 N 19TH St
Lafayette, IN 47904-2950
Phone (765) 491-0002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSPP20010440 | Other | IN | STATE BOARD OF EXAMINERS |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HSPP20010440 | IN | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186444800000",
"number": "1942491600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 N 19TH ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042950",
"telephone_number": "765-491-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 N 19TH ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042950",
"telephone_number": "765-491-0002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "DIXIE",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-07",
"last_updated": "2007-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "IN",
"license": "HSPP20010440",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF EXAMINERS",
"identifier": "HSPP20010440",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.