Kelsey Pederson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8047 Issued in OR

Practice address

1730 Sylvia CT
Turlock, CA 95382-2829

Phone

(630) 567-0949

NPI assigned

Oct 19, 2019

Sex

Female

Sole proprietor

Yes

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

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mountain River Counseling and Consulting LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bend, OR
  • NPI 1356047047
  Medicare reassignment NPD

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

{
    "created_epoch": "1571443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571443200000",
    "number": "1831732114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 SYLVIA CT",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822829",
            "telephone_number": "630-567-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 SYLVIA CT",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822829",
            "telephone_number": "630-567-0949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "KELSEY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-19",
        "last_updated": "2019-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "8047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Narges Pazouki, MD
• Bryanna Peace, MS, RD, CLE
• Dwight Alan Peace, PT
• Virginia Elisa Pease
• Anita Louise Pedersen-Pennock, PH.D.
• Teresita Pedroza-Tornero
• Maritza Pena
• Nayeli Penaloza
• Shannon Lousie Pennisi, OTR/L
• Clarissa Peralta

• Clinical Social Worker in Turlock, CA
• Providers in Turlock, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.