Mindy Jenene Pederson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

26-CRM-5720 Issued in OR

Practice address

1217 NE Burnside Rd Ste 701
Gresham, OR 97030-5770

Phone

(503) 740-1971

Fax

(503) 771-2436

NPI assigned

Sep 30, 2026

Last updated

Sep 30, 2026By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1790726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790726400000",
    "number": "1477467033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10117 SE SUNNYSIDE RD # F1217",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970157708",
            "telephone_number": "503-740-1971",
            "fax_number": "503-771-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 NE BURNSIDE RD STE 701",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305770",
            "telephone_number": "503-740-1971",
            "fax_number": "503-771-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MINDY",
        "middle_name": "JENENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-30",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "26-CRM-5720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Patton
• Monica N Payne, RDH
• Paynter Family Dentistry, PC
• Brenda Peck
• Sydney Peck
• Pediatric Associates of Gresham PC
• Pediatric Therapy Services Inc
• Pediatric Therapyworks
• Amanda Lynn Dick Pedota, PA-C
• Anne R Peel, MD

• Peer Specialist in Gresham, OR
• Providers in Gresham, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.