Ava Elizabeth Pedersen

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

9201 Old Cedar Ave S
Bloomington, MN 55425-2401

Phone

(952) 854-1800

NPI assigned

Nov 3, 2021

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

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Northway Academy, Inc.

  • Developmental Disabilities Clinic/Center
  • Saint Cloud, MN
  • NPI 1104333715
  NPD (past)
• Northway Academy, Inc.

  • Community/Behavioral Health Agency
  • Elk River, MN
  • NPI 1114539434
  NPD (past)
• Northway Academy, Inc.

  • Developmental Disabilities Clinic/Center
  • Alexandria, MN
  • NPI 1669047585
  NPD (past)
• Northway Academy, Inc.

  • Community/Behavioral Health Agency
  • Sartell, MN
  • NPI 1841852639
  NPD (past)

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1821753971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554252401",
            "telephone_number": "952-854-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554252401",
            "telephone_number": "952-854-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "59 Glenn Rd NW",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "MN",
            "postal_code": "563084007",
            "country_code": "US",
            "telephone_number": "320-219-7644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 14th Ave E",
            "address_purpose": "LOCATION",
            "city": "Sartell",
            "state": "MN",
            "postal_code": "563774500",
            "country_code": "US",
            "telephone_number": "320-774-3436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "320-774-1908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7938 College Rd",
            "address_purpose": "LOCATION",
            "city": "Baxter",
            "state": "MN",
            "postal_code": "564258636",
            "country_code": "US",
            "telephone_number": "218-270-2918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19437 Evans St NW",
            "address_purpose": "LOCATION",
            "city": "Elk River",
            "state": "MN",
            "postal_code": "553301074",
            "country_code": "US",
            "telephone_number": "763-515-3532",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "320-774-3915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "AVA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Roman Paur, DPT
• Annabel Pautsch
• PDG,P.a.
• Julie Anne Pearce, RN, CNP
• Leah M Pearce, PA-C
• Wesley Pederson
• Stephen Lee Peery, MD
• Ella Marie Pehrson
• Corinne Alise Peick, MA, OTR/L
• Denise Rae Peick, OTR L

• All providers in Bloomington, MN
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.