DR. DIXIE J PEDERSON


Address: 2 N 19th St, Lafayette, IN 47904-2950
Phone: 7654910002

DR. DIXIE J PEDERSON (NPI# 1942491600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1942491600
Entity Type Individual
Full Name DR. DIXIE J PEDERSON
Credential PH.D.
Practice Address 2 N 19th St
Lafayette
IN 47904-2950
Practice Telephone 7654910002
Mailing Telephone 7654910002
Enumeration Date 2007-08-07
Last Update Date 2007-08-07
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TH0100X Psychologist
Specialization: Health Service
HSPP20010440 IN Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
IN STATE BOARD OF EXAMINERS HSPP20010440 01

Office Location

Street Address 2 N 19TH ST
City LAFAYETTE
State IN
Zip Code 47904-2950

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Taxonomy Information

Taxonomy Code 103TH0100X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Health Service

Taxonomy Definition

A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition]

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NPI Name Taxonomy Address Enumeration
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NPI Name Taxonomy Address Enumeration
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Competitor

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City LAFAYETTE
Zip Code 47904

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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