Amy Beth Pederson, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7434 Issued in MN

Practice address

7006 Greenwood CT
Rockford, MN 55373-4581

Phone

(612) 961-8310

NPI assigned

Mar 8, 2007

Last updated

Apr 1, 2009By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238544000000",
    "number": "1083745244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 266",
            "city": "ROCKFORD",
            "state": "MN",
            "postal_code": "553730266",
            "telephone_number": "612-961-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7006 GREENWOOD CT",
            "city": "ROCKFORD",
            "state": "MN",
            "postal_code": "553734581",
            "telephone_number": "612-961-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "AMY",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2009-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "7434",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "FILE FOLDER # 389213",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA TAX ID #",
            "identifier": "5727164",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PROVIDER NUMBER",
            "identifier": "4601172",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PARTICIPAT. PROVID.#",
            "identifier": "146T2PE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Gerard Lynch, CMD
• Gladys Kerubo Machogu, RN
• Stacy Nathan
• Nicole Lyn O'Neill
• Cheyne Summer Page
• Thomas Ervin Peterson, D.C.
• Sarah Prestegard, DPT
• Provisional Home Health LLC
• Kelley Reed, MA, LPCC
• John Christopher Rehorst

• Speech-Language Pathologist in Rockford, MN
• Providers in Rockford, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.