Female

Ms. Ellen C. Pederson-lewis LCSW

Full Name

Ms. Ellen Claire Pederson-lewis LCSW

NPI Number

1649306317

NPI Type

Individual Provider

Gender

Female

Enumeration Date

02/26/2007

Specialties

(Taxonomies)

Code

1041C0700X
106H00000X

Primary Taxonomy

No
No

Licenses

State

Wisconsin
Wisconsin

License Number

1679-123
401-124

Contact
Information

Purpose

Mailing
Location

Address

7717 N BOYD WAY
675 N BROOKFIELD RD

City

Fox Point
Brookfield

State

WI
WI

Postal Code

53217-3210
53045-5858

Country

US
US

Telephone Number

(414) 690-2197
(262) 641-9300

Identifiers

Identifier

39296900

Identifier State

WI

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address