Simon S Tedrow, SUDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60215848 Issued in WA

Practice address

8514 W Gage Blvd Ste G
Kennewick, WA 99336-8108

Phone

(877) 522-1275

NPI assigned

Apr 11, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Ideal Balance PLLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kennewick, WA
  • NPI 1013343474
  NPD (past)
• Our Lady of Lourdes Hosptial at Pasco

  • Community/Behavioral Health Agency
  • Kennewick, WA
  • NPI 1114476496
  NPD (past)

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1295199743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 SINAI CT",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993018243",
            "telephone_number": "877-522-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8514 W GAGE BLVD STE G",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993368108",
            "telephone_number": "877-522-1275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 N Morain St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Kennewick",
            "state": "WA",
            "postal_code": "993362967",
            "country_code": "US",
            "telephone_number": "509-783-0500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1175 Carondelet Dr",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993543300",
            "country_code": "US",
            "telephone_number": "509-943-9104 x7288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEDROW",
        "first_name": "SIMON",
        "middle_name": "S",
        "credential": "SUDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60215848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Jane Taylor, MHC
• Rebecca Lynn Taylor, D.C.
• Valerie A Taylor, A.A.S.
• William Lee Taylor, CRNA
• Teddy Bear Obstetrics & Gynecology PS
• Tee Tee Birth Doula, LLC
• Tyson Teeples, DMD, MD
• Jenny Tegrotenhuis, M.A., M.ED., LMHC
• Malia Lynn Templeton
• Tender Connection Home Care Agency LLC

• Addiction (Substance Use Disorder) Counselor in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

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

Verify at the official NPI Registry.