Walter Pedersen, CADC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2494 Lake Tahoe Blvd Ste B2
South Lake Tahoe, CA 96150-7142

Phone

(530) 541-4594

NPI assigned

May 3, 2007

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1730301128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3668 SPRUCE AVE",
            "address_2": "APT. 19",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507497",
            "telephone_number": "530-388-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2494 LAKE TAHOE BLVD STE B2",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507142",
            "telephone_number": "530-541-4594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "WALTER",
        "credential": "CADC II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabrina Owen, LMFT
• Michael Dominick Pardo, CADC
• Eric Song Joon Park, D.D.S.
• Jill Parmele, OTR
• Marianne Elizabeth Patino, DPT
• Sarah Pendergrast, DPT
• Diana Perez
• Anna Marie Petersen, FNP-BC
• Christy Petty
• Rebecca K Phillipsen, MSW, LCSW

• Addiction (Substance Use Disorder) Counselor in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; 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.