Doctor Name: | MR. VINCENT PEDERSON |
NPI Number: | 1174677413 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CCC-SLP |
License Number: | |
Business Practice Address: | 1442 Old Skokie Rd Highland Park, IL - 600353032 |
Business Phone Number: | 8474864140 |
Business Fax Number: | |
Mailing Address: | 18483 W Geier Rd, GURNEE |
State: | IL |
Postal Code: | 600311305 |
Phone Number: | 2246437713 |
Fax Number: | |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |