Jessica Suzanne Pedersen, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

60540879 Issued in WA

Practice address

812 NW 12TH St
Pendleton, OR 97801

Phone

(541) 310-8572

NPI assigned

Jun 22, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535760000000",
    "number": "1073995429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 NW 12TH ST",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978011232",
            "telephone_number": "541-310-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 NW 12TH ST",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "97801",
            "telephone_number": "541-310-8572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "JESSICA",
        "middle_name": "SUZANNE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2018-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "20139",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "60540879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia J Winn MD
• Karen D Patton
• Paul Deutschlander LLC
• Michael Payne
• Elizabeth Anne Pearson, MSW
• Amber Lynn Pederson, CRNA
• Pediatric Specialists of Pendleton, LLC
• Pediatric Specialists of Pendleton, LLC
• Tami Jo Pelles
• Pearla Diana Pena, CADC I

• Massage Therapist in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.