Mary R Pederson, BA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SWI.LW.70056120 Issued in WA

Practice address

711 E 3Rd Ave
Spokane, WA 99202-2211

Phone

(509) 838-4651

NPI assigned

Mar 17, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frontier Behavioral Health

  • Community/Behavioral Health Agency
  • Spokane, WA
  • NPI 1861495327

  Social Worker

  NPD (past)

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785542400000",
    "number": "1306472873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S DIVISION ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021510",
            "telephone_number": "509-838-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E 3RD AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022211",
            "telephone_number": "509-838-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MARY",
        "middle_name": "R",
        "credential": "BA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2026-08-01",
        "certification_date": "2026-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "SWI.LW.70056120",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61052785",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SWI.LW.70056120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carissa Peden, LMHC
• Grace Dorothea Pedersen
• Taija Elizabeth Pedersen
• Tyler Christian Pedersen, M.D.
• Brad William Pederson, B.A
• Pediatric Associates of Spokane
• Pediatric Critical Care Associates PS
• Pediatric Dental Anesthesiologists
• Pediatric Dental Anesthesiologists PLLC (Pda)
• Pediatric Orthotic and Prosthetic Services - Northwest, LLC

• Clinical Social Worker in Spokane, WA
• Providers in Spokane, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2026; 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.