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DR. SANFORD LLOYD PEDERSON PH.D.

Clinical Neuropsychologist

Greenwood, Indiana

Provider NPI: 1659589885

Provider Information:
DR. SANFORD LLOYD PEDERSON PH.D.
Gender: M
Not Sole Proprietor

Practice Location:
494 S EMERSON AVE SUITE C GREENWOOD, IN 46143 US
Tel: 317-889-3901  Fax: 317-889-3902

Business Mailing Address:
494 S EMERSON AVE SUITE C GREENWOOD, IN 46143 US
Tel: 317-889-3901  Fax: 317-889-3902

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IN20041487
N103T00000XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TA0700XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TF0200XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TH0100XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TR0400XBehavioral Health & Social Service Providers
Psychologist
IN20041487
N103TH0004XBehavioral Health & Social Service Providers
Psychologist
IN20041487

Other Provider Identifiers:

IssuerNumberStateType
MEDICARE LEGACY ID225420A01
200227370IN05
MEDICATE PTAN22542001
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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