Individual provider Active NPI

Kaela Feddersen, M.S.

  • Speech-Language Pathologist
  • Waconia, MN
National Provider Identifier
1700418241
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
9346 Oak Ave
Waconia, MN 55387-9422
Phone
(712) 330-7349
NPI assigned
Feb 12, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 528939 MN
Speech-Language Pathologist 235Z00000X CO Primary

Addresses

Primary practice location

9346 Oak Ave
Waconia, MN 55387-9422

Mailing address

1832 Spring Creek Dr
Carver, MN 55315-4573
Phone (712) 330-7349

Other names 1

  • Kaela Delperdang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240724000910 MN Practitioner - Qualified Speech Language Pathologist 4688110851 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Sunnydays Therapy Inc Speech-Language Pathologist CurrentSince Jul 8, 2024 Accepting new patients

Locations

15265 Minnetonka Blvd
Minnetonka, MN 55345

9346 Oak Ave
Waconia, MN 55387
Phone (952) 442-5812

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.

NPI Registry JSON

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1700418241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 SPRING CREEK DR",
            "city": "CARVER",
            "state": "MN",
            "postal_code": "553154573",
            "telephone_number": "712-330-7349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9346 OAK AVE",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879422",
            "telephone_number": "712-330-7349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDDERSEN",
        "first_name": "KAELA",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-12",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "528939",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAELA",
            "last_name": "DELPERDANG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.