Active NPI
Raelynn Pedersen, LPC
- Professional Counselor
- Rifle, CO
National Provider Identifier
1194043760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 11229
- Practice address
- 501 Airport Rd
Rifle, CO 81650-8510 - Phone
- (970) 625-3582
- Fax
- (970) 625-9707
- NPI assigned
- May 6, 2010
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 11229 | CO | Primary |
Addresses
Primary practice location
501 Airport Rd
Rifle, CO 81650-8510
Mailing address
515 28 3/4 Rd
BLDG a
Grand Junction, CO 81501-5016
Phone (970) 683-7107
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60835338 | Medicaid | CO |
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 |
|---|---|---|---|
| 11229 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1194043760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 28 3/4 RD",
"address_2": "BLDG A",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815015016",
"telephone_number": "970-683-7107",
"fax_number": "970-255-3963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 AIRPORT RD",
"city": "RIFLE",
"state": "CO",
"postal_code": "816508510",
"telephone_number": "970-625-3582",
"fax_number": "970-625-9707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "RAELYNN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "11229",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60835338",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rifle, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.