Active NPI
Jeffrey Carl Pedersen, LADC
- Addiction (Substance Use Disorder) Counselor
- Lake Elmo, MN
National Provider Identifier
1750190492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 305311
- Practice address
- 9896 57TH St N
Lake Elmo, MN 55042-9588 - Phone
- (651) 285-2865
- NPI assigned
- Jan 7, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305311 | MN | Primary |
Addresses
Primary practice location
9896 57TH St N
Lake Elmo, MN 55042-9588
Mailing address
9896 57TH St N
Lake Elmo, MN 55042-9588
Phone (651) 285-2865
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305311 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736208000000",
"number": "1750190492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9896 57TH ST N",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550429588",
"telephone_number": "651-285-2865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9896 57TH ST N",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550429588",
"telephone_number": "651-285-2865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "JEFFREY",
"middle_name": "CARL",
"credential": "LADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-07",
"last_updated": "2025-01-07",
"certification_date": "2025-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "305311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elmo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.