Active NPI
Krista Pederson, CADC
- Addiction (Substance Use Disorder) Counselor
- West Des Moines, IA
National Provider Identifier
1174033518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 16028
- Practice address
- 1211 Vine St
West Des Moines, IA 50265-4472 - Phone
- (515) 414-8059
- Fax
- (515) 209-7081
- NPI assigned
- Oct 11, 2017
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16028 | IA | Primary |
Addresses
Primary practice location
1211 Vine St
West Des Moines, IA 50265-4472
Mailing address
1211 Vine St
West Des Moines, IA 50265-4472
Phone (515) 414-8059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16028 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507680000000",
"number": "1174033518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 VINE ST",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502654472",
"telephone_number": "515-414-8059",
"fax_number": "515-209-7081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 VINE ST",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502654472",
"telephone_number": "515-414-8059",
"fax_number": "515-209-7081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "KRISTA",
"credential": "CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-11",
"last_updated": "2017-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IA",
"license": "16028",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.