Melissa Lynn Pederson, MA,LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305465 Issued in MN

Practice address

4615 Grand Ave Ste 300
Duluth, MN 55807-2749

Phone

(218) 282-2174

Fax

(218) 600-5485

NPI assigned

Aug 10, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1154096378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 233",
            "city": "KNIFE RIVER",
            "state": "MN",
            "postal_code": "556090233",
            "telephone_number": "218-282-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4615 GRAND AVE STE 300",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072749",
            "telephone_number": "218-282-2174",
            "fax_number": "218-600-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MELISSA",
        "middle_name": "LYNN",
        "credential": "MA,LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noah Walter Pearson, DPT
• Delaney Rae Pease, GC
• Ernest Merrill Peaslee
• Kelsey Jo Peaslee, APRN, CNP
• Peder B Morse DDS, PA
• Nicole L Pederson, M.S.,C.G.C
• Lyn Clark Pegg, EDD, MS, LP
• Heidy L. Peloquin, CCC-SLP
• Ahna L Pelto, LICSW
• Matthew Grant Penning, M.D.

• Addiction (Substance Use Disorder) Counselor in Duluth, MN
• Providers in Duluth, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.