Basic Information
| Provider Information | |||||||||
| NPI: | 1356620975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEDALINO | ||||||||
| FirstName: | CHLOE | ||||||||
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| Credential: | LICSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2577 NE COURTNEY DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977017752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413227500 | ||||||||
| FaxNumber: | 5413227565 | ||||||||
| Practice Location | |||||||||
| Address1: | 51340 HIGHWAY 97 | ||||||||
| Address2: | |||||||||
| City: | LA PINE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977399871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178552674 | ||||||||
| FaxNumber: | 6178552895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 120208 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L12294 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.