Active NPI
Stephanie P Pedersen, L.P.
- Psychologist
- Minnetonka, MN
National Provider Identifier
1104070952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP 4964
- Practice address
- 5125 County Road 101, Suite 300
Relate, Inc.
Minnetonka, MN 55345 - Phone
- (952) 932-7277
- Fax
- (952) 932-9827
- NPI assigned
- Nov 6, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP 4964 | MN | Primary |
Addresses
Primary practice location
5125 County Road 101, Suite 300
Relate, Inc.
Minnetonka, MN 55345
Mailing address
5125 County Road 101, Suite 300
Relate, Inc.
Minnetonka, MN 55345
Phone (952) 932-7277
Other practice location 1
15320 Minnetonka Blvd
#200
Minnetonka, MN 55345
Phone (952) 932-7277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 4964 | MN | MD | Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1285740217
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1104070952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5125 COUNTY ROAD 101, SUITE 300",
"address_2": "RELATE, INC.",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "55345",
"telephone_number": "952-932-7277",
"fax_number": "952-932-9827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5125 COUNTY ROAD 101, SUITE 300",
"address_2": "RELATE, INC.",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "55345",
"telephone_number": "952-932-7277",
"fax_number": "952-932-9827"
}
],
"practiceLocations": [
{
"address_1": "15320 Minnetonka Blvd",
"address_2": "#200",
"address_purpose": "LOCATION",
"city": "Minnetonka",
"state": "MN",
"postal_code": "55345",
"country_code": "US",
"telephone_number": "952-932-7277",
"fax_number": "952-932-9827",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEDERSEN",
"first_name": "STEPHANIE",
"middle_name": "P",
"credential": "L.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-06",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP 4964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.