Breanne Ashly Pedersen
Professional Counselor
422 Tracy Ct
Crystal Lake
, Illinois 60014-6288
Breanne Ashly Pedersen
Professional Counselor
422 Tracy Ct
Crystal Lake
, Illinois 60014-6288
(815) 391-1000
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About
Features
Specialties
- Professional Counselor
Languages spoken
- English
Location
First Address
- Breanne Ashly Pedersen
- 1021 N Mulford Rd
- Rockford, IL
- Zip : 61107-3874
- Phone : (815) 391-1000
Second Address
- Breanne Ashly Pedersen
- 422 Tracy Ct
- Crystal Lake, IL
- Zip : 60014-6288
- Phone : (815) 528-9325
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 101YP2500X | Professional Counselor | 178015896 | IL |
National Provider Identifier
| NPI | 1003433715 |
|---|---|
| Provider Name | Breanne Ashly Pedersen |
| First Address | Rockford, IL 61107-3874 |
| Second Address | Crystal Lake, IL 60014-6288 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/06/2020 |
| Last Update Date | 29/06/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.