| Gwen Pedersen Llc | |
|
600 25th Ave S Ste 109 Saint Cloud MN 56301-4820 | |
| (320) 260-8313 | |
| (320) 654-0318 |
| Full Name | Gwen Pedersen Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 600 25th Ave S Ste 109, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Gwen Pedersen (MARRIAGE & FAMILY THERAPIST) |
| Authorized Official Contact | 3202550343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwen Pedersen Llc 600 25th Ave S Ste 109 Saint Cloud MN 56301-4820 Ph: (320) 260-8313 | Gwen Pedersen Llc 600 25th Ave S Ste 109 Saint Cloud MN 56301-4820 Ph: (320) 260-8313 |
| NPI Number | 1750090858 |
|---|---|
| Provider Enumeration Date | 11/16/2022 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 2062858301 |
|---|---|
| Medicare Enrollment ID | O20240308003692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750090858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Gwen Katrina Pedersen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902905516 PECOS PAC ID: 3971949215 Enrollment ID: I20240308003704 |
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