Trisha Joann Pederson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

01616 Issued in OR

Practice address

1409 NE Diamond Lake Blvd Ste 110
Roseburg, OR 97470-3356

Phone

(541) 440-4776

NPI assigned

May 30, 2025

Last updated

May 30, 2025By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1245123132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2784 TENMILE VALLEY RD",
            "city": "TENMILE",
            "state": "OR",
            "postal_code": "974819768",
            "telephone_number": "541-378-7519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 NE DIAMOND LAKE BLVD STE 110",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703356",
            "telephone_number": "541-440-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "TRISHA",
        "middle_name": "JOANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "01616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Paulsen
• Elisabeth Erin Payne
• Sandy Kay Payne, O.D.
• Imani Renee Payton, LPCC
• Tiffany Paz
• Mark Pedginski
• Misha Marie Peel, DO
• Shelby Rose Pehlke
• Mark Pequignot, DNP FNP
• Alexia Jannet Perez, MSW,MS,LCSW

• Speech-Language Pathologist in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; 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.