WALTER PEDERSEN CADC II NPI 1730301128

NPI Information

NPI: 1730301128
Provider Name: WALTER PEDERSEN, CADC II
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
2494 LAKE TAHOE BLVD STE B2
SOUTH LAKE TAHOE, CA
ZIP 96150
Phone: (530) 541-4594
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Walter Pedersen, CADC II is an addiction (substance use disorder) counselor in South Lake Tahoe, CA. Walter Pedersen, CADC II NPI is 1730301128. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2494 LAKE TAHOE BLVD STE B2
SOUTH LAKE TAHOE, CA
ZIP 96150-142
Phone: (530) 541-4594

The enumeration date for this NPI number is 5/3/2007 and was last updated on 4/10/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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