Cortney Pederson, MSW LICSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

15940 Issued in MN

Practice address

6600 France Ave S
Ste 320
Edina, MN 55435-1805

Phone

(952) 835-2002

Fax

(952) 835-9889

NPI assigned

Sep 20, 2006

Last updated

Jan 22, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Cortney Lynn Sidwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Youable Emotional Health Services

  • Community/Behavioral Health Agency
  • Richfield, MN
  • NPI 1386728228
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1396843413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S",
            "address_2": "STE 230",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351805",
            "telephone_number": "952-835-2002",
            "fax_number": "952-835-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S",
            "address_2": "STE 320",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351805",
            "telephone_number": "952-835-2002",
            "fax_number": "952-835-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "CORTNEY",
        "credential": "MSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "15940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "199P1ST",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "4045202",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "954694400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "4045202",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP49679",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORTNEY",
            "last_name": "SIDWELL",
            "middle_name": "LYNN",
            "credential": "MSW LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pearle Vision Inc (Pearle Vision #C6706)
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• Andrew Graham Pearson, DDS
• Bradley L Pearson, D.D.S.,M.S.
• Scot A. Pearson, D.C.
• Erin Therese Pederson, CNP, FNP-C
• Lane Daniel Pederson, PSYD LP
• Pediatric Neuropsychology Services, P.C.
• Douglas Pelcak, MA
• Katherine Mary Pellant Kaufman, ATC

• Psychologist in Edina, MN
• Providers in Edina, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; 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.