Active NPI
Nicky Diane Bredeson, LICSW LMFT
- Marriage & Family Therapist
- Edina, MN
National Provider Identifier
1487717344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- L.M.F.T.564
- Practice address
- 4005 West 65TH St
#108
Edina, MN 55435-1700 - Phone
- (952) 929-1819
- Fax
- (952) 929-0022
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L.I.C.S.W. 257 | MN | |
| Marriage & Family Therapist | 106H00000X | L.M.F.T.564 | MN | Primary |
Addresses
Primary practice location
4005 West 65TH St
#108
Edina, MN 55435-1700
Mailing address
4005 West 65TH St
#108
Edina, MN 55435-1700
Phone (952) 929-1819
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LICSW257 | Other | MN | LICENSE NUMBER |
| LMFT564 | Other | MN | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L.I.C.S.W. 257 | MN | MD | Clinical Social Worker |
| L.M.F.T.564 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associated Clinic of Psychology Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- St Louis Park, MN
- NPI 1588741292
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1487717344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 WEST 65TH ST",
"address_2": "#108",
"city": "EDINA",
"state": "MN",
"postal_code": "554351700",
"telephone_number": "952-929-1819",
"fax_number": "952-929-0022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 WEST 65TH ST",
"address_2": "#108",
"city": "EDINA",
"state": "MN",
"postal_code": "554351700",
"telephone_number": "952-929-1819",
"fax_number": "952-929-0022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREDESON",
"first_name": "NICKY",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"credential": "LICSW LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "L.I.C.S.W. 257",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "L.M.F.T.564",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "LICSW257",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "LMFT564",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.